Gastric Cancer最新文献

Background: Telesurgery is gaining traction across surgical specialties. However, its use in radical gastrectomy for gastric cancer remains limited. This study evaluated the safety and feasibility of fifth-generation (5G) robot-assisted remote radical gastrectomy using the Toumai Endoscopic Surgery Robotic System.

Methods: In this prospective single-center single-arm clinical study, eligible patients underwent 5G remote radical gastrectomy over a distance of 15 km. The primary outcome was the incidence of intraoperative and postoperative complications. Secondary outcomes included surgical completion rate, operative duration, estimated blood loss, number of lymph nodes dissected, time to first flatus and diet, and hospital stay.

Results: Twenty-seven patients were enrolled between September and December 2023. All surgeries were completed successfully, with no conversion and a 100% R0 resection rate. No intraoperative complications occurred. Postoperative complications occurred in 18.5% of patients, with no Clavien-Dindo grade ≥ III. The mean operative time was 192.6 ± 34.8 min, and mean blood loss was 35.9 ± 15.9 mL. Lymph nodes were dissected at an average of 38.4 ± 13.2 lymph nodes. Median time to first flatus and oral intake was 2.0 days, to liquid diet was 4.0 days, and hospital stay was 7.0 days. The 5G network was highly stable, with total delay of 226.2 ± 4.4 ms, round-trip delay of 31.6 ± 3.8 ms, and packet loss < 0.1%.

Conclusions: The 5G robot-assisted remote radical gastrectomy using the Toumai system is safe and feasible for selected patients with gastric cancer. The integration of 5G and robotics may offer a promising telemedicine approach to surgical oncology.

Objective: This study aimed to evaluate the impact of drain placement on the incidence of postoperative complications in patients undergoing gastrectomy.

Background: The effectiveness of prophylactic abdominal drain placement in gastrectomy remains unclear. Nevertheless, they are still commonly used following gastrectomy.

Methods: We conducted a retrospective cohort study using a nationwide inpatient database in Japan. Patients who underwent gastrectomy for gastric cancer between January 2014 and March 2022 were included. We applied overlap weighting based on propensity scores to adjust for baseline characteristics. The primary outcome was the incidence of intra-abdominal infections. Secondary outcomes included postoperative percutaneous drainage, in-hospital death, length of hospital stay, and total hospitalization costs.

Results: A total of 217,750 patients met the inclusion criteria, and 196,660 (90.3%) received prophylactic abdominal drains. After overlap weighting, the drain group had a significantly lower incidence of intra-abdominal infections compared to the no-drain group (6.3% vs. 7.6%; 95% confidence interval [CI] - 1.7 to - 1.0). The prophylactic drains were also associated with reduced in-hospital postoperative mortality (0.6% vs. 0.8%; 95% CI - 0.3 to - 0.1). No significant differences were observed between the two groups in postoperative percutaneous drainage or hospital stay duration.

Conclusion: This study suggests that prophylactic abdominal drainage was associated with a reduced incidence of intra-abdominal infections after gastrectomy without increasing hospitalization duration or medical costs.

Background & aims: The role of histone lysine lactylation (Kla) in gastric cancer mesenchymal stromal cells (GCMSCs) remains elusive. This study aimed to investigate the potential lactyltransferase and the influence of histone Kla in GCMSCs.

Methods: Histone Kla levels in GCMSCs were characterized by cell immunofluorescence and Western blotting. The transcriptional regulation was validated via CUT&Tag sequencing coupled with qPCR analysis. Immunosuppressive effectors through Western blotting and multiplex immunohistochemistry (mIHC). β-alanine and AZD3965 were applied to inhibit histone Kla in vitro. Ultimately, β-alanine was selected for its ability to enhance the efficacy of anti-PD-1 therapy in NCG^PBMC tumor-bearing model.

Results: The primary GCMSCs exhibited higher histone Kla levels. Lactate treatment triggered the nuclear translocation of aminoacyl-tRNA synthetase 1 (AARS1), whose knockdown attenuated lactate-driven nuclear accumulation and suppressed histone Kla. CUT&Tag-qPCR analysis revealed lactate-induced Pan-Kla enrichment at the FAP promoter, driving extracellular matrix (ECM) receptor interaction pathways. Deeply, H4K8 lactylation (H4K8la) has been defined as the key regulatory role to promote FAP transcription, corroborated by mIHC mapping of their immune-excluded spatial organization. In NCG^PBMC tumor-bearing models, β-alanine synergized with anti-PD-1 therapy, enhancing tumor regression and augmenting CD8⁺ T cell effector functions.

Conclusions: We elucidate a Kla-dependent mechanism underlying GCMSCs-mediated ECM remodeling and immunosuppressive niche formation. The results provide novel insights into the epigenetic regulation of immunosuppressive TME.

Valvuloplastic esophagogastrostomy by a double flap technique has promise for preventing reflux after proximal gastrectomy. However, a short esophageal remnant sometimes strongly complicates the transhiatal procedure for alimentary tract reconstruction. We therefore developed secure robotic techniques for right transthoracic esophagogastrostomy by a double flap technique. To accomplish valvuloplastic esophagogastrostomy by this double flap technique in the right thorax of patients in the prone position, the esophagus and stomach were partially fixed before rotating these two organs to expose the anterior gastric wall side for anastomosis because it was invisible in the right thorax. However, this rotation process was complicated. Doubting that the required anastomosis that was conventionally created in the layout of the ventral esophagus and dorsal stomach in valvuloplastic esophagogastrostomy by a double flap technique protected against reflux, we have considered that, if the anastomosis is created at the posterior gastric wall, it may not be necessary to rotate the remnant esophagus and stomach. We herein describe a modified robotic procedure for right transthoracic valvuloplastic esophagogastrostomy incorporating a double flap technique. In this procedure, the anastomosis is created at the posterior remnant gastric wall under a natural operative view without re-arranging the anastomotic organs. This modified technique simplifies right transthoracic valvuloplastic esophagogastrostomy by a double flap technique without adversely influencing anti-acid reflux mechanisms.

Background: Undifferentiated-type gastric cancer (UGC) is more pathologically aggressive and progresses faster than differentiated-type gastric cancer (DGC). However, the impact of Helicobacter pylori (Hp) status on survival outcomes and clinicopathological features of UGC remains unclear.

Methods: This multi-center retrospective study analyzed 571 patients pathologically confirmed UGC from January 2011 to December 2021. Clinical and histopathological features and survival outcomes were compared between Hp-naïve undifferentiated-type gastric cancer (HpNUGC) and Hp-infected undifferentiated-type gastric cancer (HpIUGC).

Results: 571 patients including 283 HpNUGC (49.6%) and 288 HpIUGC (50.4%) were enrolled in survival analysis. The 5-year event-free survival (EFS) and 5-year overall survival (OS) rates were significantly lower in the HpNUGC group compared to the HpIUGC group (EFS: 46.3% vs. 64.3%, P < 0.001; OS: 54.3% vs. 67.7%, P < 0.001). Hp-naïve status was associated with a 57% higher risk of disease progression, recurrence, or death, collectively termed "events" in this study (HR 1.57; 95% CI 1.20-2.04), and a 50% higher risk of all-cause mortality (HR 1.50, 95% CI 1.12-2.00). The HpNUGC lesions demonstrated larger tumor diameters (P < 0.001), deeper invasion depths (P < 0.001), more frequent lymphatic metastasis (P = 0.003), more advanced disease stages (P = 0.002), and higher rates of positive incision margins (P = 0.049).

Conclusion: HpNUGC is associated with worse survival outcomes and exhibits more malignant pathological features compared to HpIUGC. Future prospective studies are needed to clarify the relationship between Hp status and the development and progression of UGC.

Background: Palliative resection for metastatic gastric cancer is not recommended in current practice guidelines; however, it is frequently performed based on clinical considerations. Prospective trials face challenges, necessitating large-scale retrospective analyses to provide clinical evidence.

Methods: The PASS-META study group established a cohort of 983 patients with gastric cancer with surgically confirmed metastatic lesions treated at five major Korean institutions from 2014 to 2021, collecting 126 variables from preoperative, operative, and postoperative data through hospital records. The correlation between gastrectomy and survival outcomes was investigated using inverse probability of treatment weighting (IPTW) and standardization to estimate counterfactual outcomes.

Results: Machine learning-based imputation and statistical causal survival analysis revealed that gastrectomy was found to significantly improve survival in patients with limited peritoneal metastasis (P1 or P2; RR: 0.90, 95% CI 0.85-0.94), as well as in those with distant lymph node metastasis (dLN1; RR: 0.92, 95% CI 0.91-0.94) and hepatic metastasis (H1; RR: 0.92, 95% CI 0.82-1.00), suggesting a potential survival advantage across these subgroups. No survival benefit was observed in patients with severe peritoneal metastasis (P3). Among patients with P1-P2 metastasis, extensive lymph node dissection improved the 5-year survival rates compared with limited dissection, whereas minimally invasive surgery did not affect the survival outcome. Although gastrectomy increased the postoperative hospital stay and delayed the initiation of the first postoperative chemotherapy compared to patients without gastrectomy, it did not affect the total number of chemotherapy cycles.

Conclusion: This study suggests that gastrectomy offers a significant survival benefit to patients with surgically proven stage IV gastric cancer and limited peritoneal metastasis (P1/P2), distant lymph node (dLN1), or hepatic metastases (H1). Furthermore, specific surgical procedures such as extended lymph node dissection or minimally invasive surgery may be considered for patients undergoing gastrectomy.

Background: Leptomeningeal carcinomatosis (LMC) is a rare but highly lethal manifestation of gastric cancer. We sought to describe its clinical features and define prognostic factors in a large single-center cohort.

Methods: We retrospectively reviewed 86 patients diagnosed with LMC secondary to gastric cancer at Samsung Medical Center between 2008 and 2024.

Results: The median interval from primary gastric cancer diagnosis to LMC development was 12.0 months (range, 0-106). Common presenting symptoms included headache (73.3%), nausea/vomiting (55.8%), and dizziness (48.8%). Primary gastric cancers were predominantly Borrmann type III (48.2%) or type IV (38.8%) and had an undifferentiated-type (96.5%) histology. Intrathecal (IT) methotrexate-based chemotherapy was administered to 54 patients (62.8%), with or without radiotherapy or systemic chemotherapy. Cytological response was seen in 14/54 patients (25.9%) who received IT chemotherapy. Decompressive therapies, including Ommaya reservoir, external ventricular drainage (EVD) and ventriculoperitoneal (VP) shunt were performed in 71/86 patients (82.6%). The median overall survival from LMC diagnosis was 6.0 weeks (95% confidence interval [CI]: 3.7-8.3). In multivariable analysis, age ≥ 60 years (HR 1.8) and ECOG PS > 2 (HR 2.8) were independent adverse prognostic factors. Univariable subgroup analyses demonstrated prolonged survival with intrathecal chemotherapy (HR 0.5), systemic chemotherapy (HR 0.4), and decompressive procedures (HR 0.3), whereas radiotherapy showed no significant benefit.

Conclusions: The prognosis of gastric cancer patients with LMC remains extremely poor, and older age and poor performance status were independent adverse prognostic factors. As intrathecal chemotherapy, systemic chemotherapy, and decompressive therapies may improve survival, an individualized, multidisciplinary treatment approach is recommended.

Background: Corpus atrophic gastritis (CAG) requires endoscopic-histological surveillance due to the risk of developing gastric neoplastic lesions (GNL). This study aimed to identify variables associated with GNL development at long-term follow-up using a Fisher score-based feature-ranking-approach coupled with a One-Class Support-Vector-Machine (SVM) model.

Methods: A dataset containing 30 clinical, endoscopic, and histological variables from consecutive CAG patients (2001-2023) adhering to a surveillance-program was considered. GNL presence at the longest available follow-up was recorded. Gastric biopsies and histological evaluations followed the updated-Sydney-system. A Fisher score-based feature ranking method and a One-Class SVM were employed to select key variables linked to GNL development, and then validated with synthetically generated data.

Results: Overall, 355 CAG patients were initially considered. Of these, 36 were excluded due to the presence of GNL at baseline gastroscopy, and 216 for missing data. Thus, a total of 103 patients were considered and grouped into: CAG patients with [22 patients (F 68.1%), median-age 68(35-83) years] and without GNL at follow-up [81 patients (F 72.8%) median-age 59(26-84) years]. After a median follow-up of 60(12-192) months, 13 epithelial GNL (gastric adenocarcinoma or high/low-grade dysplasia) and nine type-1 gastric-neuroendocrine-tumors (T1gNET) were recorded. Parietal-cell-antibodies and pepsinogen-I < 30 μg/l were associated with epithelial GNL and T1gNET. Antral inflammation and age > 60 were linked to epithelial GNL, while anti-thyroperoxidase-antibodies, smoking, and dyspeptic-symptoms were linked to T1gNET. Low-dose aspirin and H. pylori eradication therapy showed inverse associations with epithelial GNL and T1gNET, respectively.

Conclusions: This is the first study in which an AI-model simultaneously considers clinical, endoscopic, and histological features from a dataset of CAG patients, showing the potential to identify variables associated with GNL development.