Special Issue "Surgical Management of Gastric Cancer"

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepato-Pancreato-Biliary Medicine".

Deadline for manuscript submissions: closed (20 September 2019).

Special Issue Editors

Prof. Dr. Richard van Hillegersberg
E-Mail Website
Guest Editor
Department of Surgery, University Medical Center, 3584 CX Utrecht, The Netherlands
Interests: robot surgery; minimal invasive surgery; gastrectomy; esophagectomy; lymph node dissection; nutrition
Dr. Jelle Ruurda
E-Mail Website
Guest Editor
Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht 3508 GA, The Netherlands
Interests: minimally invasive surgery; robotics; value-based healthcare; upper GI surgery

Special Issue Information

Dear Colleagues,

Gastrectomy is the cornerstone of curative treatment for patients with gastric cancer. Minimally invasive gastrectomy may improve the surgical outcome; however, it remains unclear to which extent it is superior to open techniques. Furthermore, the role of robotics and sentinel node biopsy needs to be established. For gastroesophageal junction tumors, the optimal surgical approach is less clear and may consist of a gastrectomy or esophagectomy.

In advanced stage, a D2 lymphadenectomy is the standard of care, whereas the role of D3 lymphadenectomy in the Western population needs to be established, as well as the oncological importance of omentectomy.

The treatment of patients with oligometastatic disease or peritoneal metastases is changing rapidly as new neoadjuant treaments combined with HIPEC are being investigated.

Enhanced recovery programs have been introduced to quicken postoperative recovery by early mobilisation and feeding. The use of jejunostomy tube feeding is under debate.

Evidence regarding the optimal staging of gastric cancer and timing of treatment is lacking, and the same applies to the follow-up regimen.

This Special Issue aims to give insight into the mentioned aspects of surgical gastric cancer treatment, whith emphasis on the new developments of multimodality treatment and fast recovery programs leading to increased survival with improved quality of life.

Prof. Dr. Richard van Hillegersberg
Dr. Jelle Ruurda
Guest Editors

Manuscript Submission Information

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Keywords

  • Gastric cancer
  • Surgery
  • Minimally invasive gastrectomy
  • Robotic surgery
  • Sentinel node
  • Multimodality treatment
  • HIPEC
  • Staging
  • Prognostication
  • Oligometastases
  • Follow-up
  • ERAS

Published Papers (5 papers)

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Research

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Open AccessArticle
Significance of the Glasgow Prognostic Score in Predicting the Postoperative Outcome of Patients with Stage III Gastric Cancer
J. Clin. Med. 2019, 8(9), 1448; https://doi.org/10.3390/jcm8091448 - 12 Sep 2019
Abstract
This study aimed at investigating the ability of a preoperative Glasgow prognostic score (GPS) to predict postoperative complications and survival outcomes in patients with stage III gastric cancer undergoing D2 gastrectomy. We retrospectively reviewed data from 272 such patients, treated between 2010 and [...] Read more.
This study aimed at investigating the ability of a preoperative Glasgow prognostic score (GPS) to predict postoperative complications and survival outcomes in patients with stage III gastric cancer undergoing D2 gastrectomy. We retrospectively reviewed data from 272 such patients, treated between 2010 and 2016, at a Taiwanese medical center. The patients were categorized according to their GPS. In total, 36.8%, 48.5%, and 14.7% of the patients were assigned to groups with a GPS of 0, 1, and 2, respectively. Overall surgical complication rates in these groups were 30%, 45.5%, and 52.5% (p = 0.016); postoperative intensive care unit admission rates were 10%, 14.4%, and 22.5% (p = 0.15); postoperative 30-day re-admission rates were 6%, 15.2%, and 20% (p = 0.034); and the in-hospital mortality rates were 1.0%, 1.5%, and 10.0%, respectively (p = 0.006). The median survival times of the patients were 42.9 months (95% confidence interval [CI], 29.1–56.6), 22.6 months (95% CI, 19.3–25.8), and 16.6 months (95% CI, 7.8–25.4), respectively (p< 0.001). A significant correlation was observed between the preoperative GPS, short-term postoperative complications, and long-term survival outcomes in patients with gastric cancer undergoing D2 gastrectomy. These findings recommend the usage of the GPS as a predictive and prognostic factor in patients with gastric cancer considering surgical resection. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer)
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Open AccessArticle
A Lesion-Based Convolutional Neural Network Improves Endoscopic Detection and Depth Prediction of Early Gastric Cancer
J. Clin. Med. 2019, 8(9), 1310; https://doi.org/10.3390/jcm8091310 - 26 Aug 2019
Abstract
In early gastric cancer (EGC), tumor invasion depth is an important factor for determining the treatment method. However, as endoscopic ultrasonography has limitations when measuring the exact depth in a clinical setting as endoscopists often depend on gross findings and personal experience. The [...] Read more.
In early gastric cancer (EGC), tumor invasion depth is an important factor for determining the treatment method. However, as endoscopic ultrasonography has limitations when measuring the exact depth in a clinical setting as endoscopists often depend on gross findings and personal experience. The present study aimed to develop a model optimized for EGC detection and depth prediction, and we investigated factors affecting artificial intelligence (AI) diagnosis. We employed a visual geometry group(VGG)-16 model for the classification of endoscopic images as EGC (T1a or T1b) or non-EGC. To induce the model to activate EGC regions during training, we proposed a novel loss function that simultaneously measured classification and localization errors. We experimented with 11,539 endoscopic images (896 T1a-EGC, 809 T1b-EGC, and 9834 non-EGC). The areas under the curves of receiver operating characteristic curves for EGC detection and depth prediction were 0.981 and 0.851, respectively. Among the factors affecting AI prediction of tumor depth, only histologic differentiation was significantly associated, where undifferentiated-type histology exhibited a lower AI accuracy. Thus, the lesion-based model is an appropriate training method for AI in EGC. However, further improvements and validation are required, especially for undifferentiated-type histology. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer)
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Open AccessArticle
Hybrid Minimally Invasive Esophagectomy–Surgical Technique and Results
J. Clin. Med. 2019, 8(7), 978; https://doi.org/10.3390/jcm8070978 - 05 Jul 2019
Abstract
Background: Hybrid minimally invasive esophagectomy (HMIE) has been proven to be superior when compared with open esophagectomy, with a significant reduction of postoperative morbidity. In HMIE, the laparotomy is replaced by a minimally invasive laparoscopic approach. The radical mediastinal resection plus reconstruction is [...] Read more.
Background: Hybrid minimally invasive esophagectomy (HMIE) has been proven to be superior when compared with open esophagectomy, with a significant reduction of postoperative morbidity. In HMIE, the laparotomy is replaced by a minimally invasive laparoscopic approach. The radical mediastinal resection plus reconstruction is performed by a thoracic approach through a muscle-sparing thoracotomy. In this instructional article, we describe the surgical technique of HMIE in detail in order to facilitate possible adoption of the procedure by other surgeons. In addition, we give the monocentric results of our own practice. Methods: Between 2013 and 2018, HMIE was performed in 157 patients. The morbidity and mortality data of the procedure is shown in a retrospective monocentric analysis. Results: Overall, 54% of patients had at least one perioperative complication. Anastomotic leak was evident in 1.9%, and a single patient had focal conduit necrosis of the gastric pull-up. Postoperative pulmonary morbidity was 31%. Pneumonia was found in 17%. The 90 day mortality was 2.5%. Wound infection rate was 3%, and delayed gastric emptying occurred in 17% of patients. In follow up, 12.7% presented with diaphragmatic herniation of the bowel, requiring laparoscopic hernia reduction and hiatal reconstruction and colopexy several months after surgery. Conclusion: HMIE is a highly reliable technique, not only for the resection part but especially in terms of safety in reconstruction and anastomosis. For esophageal surgeons with experience in minimally invasive anti-reflux procedures and obesity surgery, HMIE is easy and fast to learn and adopt. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer)
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Open AccessArticle
Association between Interleukin-6 Levels and Perioperative Fatigue in Gastric Adenocarcinoma Patients
J. Clin. Med. 2019, 8(4), 543; https://doi.org/10.3390/jcm8040543 - 20 Apr 2019
Abstract
Background: Gastric adenocarcinoma (GA), one of the most common gastrointestinal cancers worldwide, is often accompanied by cancer cachexia in the advanced stage owing to malnutrition and cancer-related symptoms. Although resection is the most effective curative procedure for GA patients, it may cause perioperative [...] Read more.
Background: Gastric adenocarcinoma (GA), one of the most common gastrointestinal cancers worldwide, is often accompanied by cancer cachexia in the advanced stage owing to malnutrition and cancer-related symptoms. Although resection is the most effective curative procedure for GA patients, it may cause perioperative fatigue, worsening the extent of cancer cachexia. Although the relationship between cytokines and cancer fatigue has been evaluated, it is unclear which cytokines are associated with fatigue in GA patients. Therefore, this study aimed to investigate whether the changes in cytokine levels were associated with the perioperative changes in fatigue amongst GA patients. Methods: We included GA patients undergoing gastric surgery in a single academic medical center between June 2017 and December 2018. Fatigue-related questionnaires, serum cytokine levels (interferon-gamma, interleukin (IL)-1, IL-2, IL-5, IL-6, IL-12 p70, tumor necrosis factor-alpha, and granulocyte-macrophage colony-stimulating factor), and biochemistry profiles (albumin, prealbumin, C-reactive protein, and white blood cell counts) were assessed at three time points (preoperative day 0 (POD 0), post-operative day 1 (POD 1), and postoperative day 7 (POD 7)). We used the Brief Fatigue Inventory-Taiwan Form to assess the extent of fatigue. The change in fatigue scores among the three time points, as an independent variable, was adjusted for clinicopathologic characteristics, malnutrition risk, and cancer stages. Results: A total of 34 patients were included for analysis, including 12 female and 22 male patients. The mean age was 68.9 years. The mean score for fatigue on POD 0, POD 1, and POD 7 was 1.7, 6.2, and 3.6, respectively, with significant differences among the three time points (P < 0.001). Among the cytokines, only IL-6 was significantly elevated from POD 0 to POD 1. In the regression model, the change in IL-6 levels between POD 0 and POD 1 (coefficients = 0.01 for every 1 pg/mL increment; 95% confidence interval: 0.01–0.02; P = 0.037) and high malnutrition risk (coefficients = 2.80; 95% confidence interval: 1.45–3.52; P = 0.041) were significantly associated with changes in fatigue scores. Conclusions: The perioperative changes in plasma IL-6 levels are positively associated with changes in the fatigue scores of GA patients undergoing gastric surgery. Targeting the IL-6 signaling cascade or new fatigue-targeting medications may attenuate perioperative fatigue, and further clinical studies should be designed to validate this hypothesis. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer)
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Review

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Open AccessReview
Prophylactic Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for Gastric Cancer—A Systematic Review
J. Clin. Med. 2019, 8(10), 1685; https://doi.org/10.3390/jcm8101685 - 15 Oct 2019
Abstract
Survival after potentially curative treatment of gastric cancer remains low, mostly due to peritoneal recurrence. This descriptive review gives an overview of available comparative studies concerning prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer with neither clinically evident metastases nor positive [...] Read more.
Survival after potentially curative treatment of gastric cancer remains low, mostly due to peritoneal recurrence. This descriptive review gives an overview of available comparative studies concerning prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer with neither clinically evident metastases nor positive peritoneal cytology who undergo potentially curative gastrectomy. After searching the PubMed, Embase, CDSR, CENTRAL and ASCO meeting library, a total of 11 studies were included comparing surgery plus prophylactic HIPEC versus surgery alone (SA): three randomised controlled trials and eight non-randomised comparative studies, involving 1145 patients. Risk of bias was high in most of the studies. Morbidity after prophylactic HIPEC was 17–60% compared to 25–43% after SA. Overall survival was 32–35 months after prophylactic HIPEC and 22–28 months after SA. The 5-year survival rates were 39–87% after prophylactic HIPEC and 17–61% after SA, which was statistically significant in three studies. Peritoneal recurrence occurred in 7–27% in the HIPEC group, compared to 14–45% after SA. This review tends to demonstrate that prophylactic HIPEC for gastric cancer can be performed safely, may prevent peritoneal recurrence and may prolong survival. However, studies were heterogeneous and outdated, which emphasizes the need for well-designed trials conducted according to current standards. Full article
(This article belongs to the Special Issue Surgical Management of Gastric Cancer)
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