How Far Are Patients Willing to Travel for Gastrectomy?

Alvino, Donna Marie L. BA^*; Chang, David C. PhD, MPH, MBA^*; Adler, Joel T. MD, MPH^*; Noorbakhsh, Abraham BS^†; Jin, Ginger MS^*; Mullen, John T. MD^*

Annals of Surgery: June 2017 - Volume 265 - Issue 6 - p 1172–1177

doi: 10.1097/SLA.0000000000001826

Original Articles

Objective: To determine travel patterns for patients undergoing gastrectomy for cancer and to identify factors associated with patient decision.

Background: Support for regionalization of complex surgery grows; however, little is known about the willingness of patients to travel for care. Furthermore, utilization of outcomes data in patients’ hospital selection processes is not well understood.

Results: Total study population was 10,022. Majority (67.1%) of patients underwent gastrectomy at the nearest providing hospitals. Distance traveled to destination hospitals in California averaged 17.04 miles. Bypassing patients traveled approximately 16 miles beyond the nearest hospitals to receive care, selecting lower volume destination hospitals in 27.9% of cases. Annual gastrectomy volumes for nearest and for destination hospitals averaged 4.4 and 6.8 cases, respectively, and inhospital mortality rates were 5.9% and 4.8%, respectively. A few patients (19.2%) sought care at teaching hospitals. Rural county residence significantly reduced the likelihood of bypass (P < 0.001). High volume (>7 cases) and teaching status of destination hospitals (both P < 0.001) were predictive of hospital bypass, though no significant association between mortality rate and bypass was identified.

Conclusions: The majority of gastric cancer patients underwent gastrectomy at providing hospitals nearest to home, reflecting little regionalization of gastrectomy in California. Patients’ hospital selection appears not to be driven by outcomes data.
http://journals.lww.com/annalsofsurgery/Abstract/2017/06000/How_Far_Are_Patients_Willing_to_Travel_for.23.aspx

Individualized Venous Thromboembolism Risk Stratification Using the 2005 Caprini Score to Identify the Benefits and Harms of Chemoprophylaxis in Surgical Patients: A Meta-analysis

Pannucci, Christopher J. MD, MS^*; Swistun, Lukasz MD^†; MacDonald, John K. MA^‡; Henke, Peter K. MD^§; Brooke, Benjamin S. MD, PhD^¶

Annals of Surgery: June 2017 - Volume 265 - Issue 6 - p 1094–1103

doi: 10.1097/SLA.0000000000002126

Meta-Analyses

Objective: We performed a meta-analysis to investigate benefits and harms of chemoprophylaxis among surgical patients individually risk stratified for venous thromboembolism (VTE) using Caprini scores.

Summary of Background Data: Individualized VTE risk stratification may identify high risk surgical patients who benefit from peri-operative chemoprophylaxis.

Conclusions: The benefit of peri-operative VTE chemoprophylaxis was only found among surgical patients with Caprini scores ≥7. Precision medicine using individualized VTE risk stratification helps ensure that chemoprophylaxis is used only in appropriate surgical patients and may minimize bleeding complications.

http://journals.lww.com/annalsofsurgery/Abstract/2017/06000/Individualized_Venous_Thromboembolism_Risk.12.aspx

Perioperative Pharmacological Thromboprophylaxis in Patients With Cancer: A Systematic Review and Meta-analysis

Guo, Qiang MD; Huang, Bin MD; Zhao, Jichun MD; Ma, Yukui MD; Yuan, Ding MD; Yang, Yi MD; Du, Xiaojiong MD

Annals of Surgery: June 2017 - Volume 265 - Issue 6 - p 1087–1093

doi: 10.1097/SLA.0000000000002074

Meta-Analyses

Methods: We searched multiple electronic databases (up to March 31, 2016) for trials of cancer patients undergoing surgery that assessed the relative benefits and harms of perioperative pharmacological thromboprophylaxis. Relative risks (RRs) with 95% confidence intervals (CI) were estimated.

Conclusions: Routine pharmacological thromboprophylaxis for cancer patients undergoing surgery needs to be carefully considered, because although thromboprophylaxis is associated with lower VTE events, there is a higher incidence of clinically significant bleeding events. If pharmacological thromboprophylaxis is to be used, extended thromboprophylaxis started preoperatively with LWMH might be the most effective strategy.

http://journals.lww.com/annalsofsurgery/Abstract/2017/06000/Perioperative_Pharmacological_Thromboprophylaxis.11.aspx

Differential Prognostic Implications of Gastric Signet Ring Cell Carcinoma: Stage Adjusted Analysis From a Single High-volume Center in Asia

Chon, Hong Jae MD^*,†; Hyung, Woo Jin MD, PhD^‡; Kim, Chan MD, PhD^*; Park, Sohee PhD^§; Kim, Jie-Hyun MD^||; Park, Chan Hyuk MD^¶; Ahn, Joong Bae MD, PhD^**; Kim, Hyunki MD^††; Chung, Hyun Cheol MD, PhD^**; Rha, Sun Young MD, PhD^**; Noh, Sung Hoon MD, PhD^‡; Jeung, Hei-Cheul MD, PhD^||

Annals of Surgery: May 2017 - Volume 265 - Issue 5 - p 946–953

doi: 10.1097/SLA.0000000000001793

Original Articles

Objective: The aim of this study was to analyze the clinicopathologic characteristics and prognosis of signet ring cell carcinoma (SRC) according to disease status (early vs advanced gastric cancer) in gastric cancer patients.

Results: SRC patients have younger age distribution and female predominance compared with other histologic subtypes. Notably, the distribution of T stage of SRC patients was distinct, located in extremes (T1: 66.2% and T4: 20%). Moreover, the prognosis of SRC in early gastric cancer and advanced gastric cancer was contrasting. In early gastric cancer, SRC demonstrated more favorable prognosis than WMD after adjusting for age, sex, and stage. In contrast, SRC in advanced gastric cancer displayed worse prognosis than WMD. As stage increased, survival outcomes of SRC continued to worsen compared with WMD.

Conclusions: Although conferring favorable prognosis in early stage, SRC has worse prognostic impact as disease progresses. The longstanding controversy of SRC on prognosis may result from disease status at presentation, which leads to differing prognosis compared with tubular adenocarinoma.

http://journals.lww.com/annalsofsurgery/Fulltext/2017/05000/Differential_Prognostic_Implications_of_Gastric.17.aspx

Postoperative quality of life after laparoscopy-assisted pylorus-preserving gastrectomy compared With laparoscopy-assisted distal gastrectomy: A cross-sectional postal questionnaire survey

Highlights

• •We surveyed patients who underwent LAPPG and LADGBI via questionnaire using newly developed questionnaire, the PGSAS-45.
• •LAPPG is superior to LADGBI for maintaining QOL.
• •LAPPG is recommended for cT1N0 middle third gastric cancer.

Background

Little is known about postgastrectomy syndrome and quality of life (QOL after laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). The aim of this study was to assess postgastrectomy syndrome and QOL after LAPPG as compared with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGBI).

Conclusion

LAPPG is superior to LADGBI for ameliorating postgastrectomy syndrome and maintaining QOL. LAPPG is recommended for patients with cT1N0 middle third gastric cancer.

http://www.americanjournalofsurgery.com/article/S0002-9610(16)30653-5/abstract

 

Influence of perineural invasion in predicting overall survival and disease-free survival in patients With locally advanced gastric cancer

 

Highlights

• •Perineural invasion (PNI) is an important pathologic feature of neoplasms.
• •Influence of PNI is used for staging in different types of tumors.
• •Prognosis of gastric cancer patients is shown to be influenced by PNI.
• •PNI should be considered to plan the best systemic treatment after surgery

Background

The aim of the present study was to evaluate the prognostic significance of perineural invasion (PNI) in locally advanced gastric cancer patients who underwent D2 gastrectomy and adjuvant chemotherapy.

Conclusions

PNI and T stage and positive lymph nodes are independent markers of poor prognosis in patients with gastric cancer. PNI should be incorporated in the postoperative staging system for planning follow-up after surgery and in our opinion to propose more aggressive postoperative therapies in PNI-positive patients.

http://www.americanjournalofsurgery.com/article/S0002-9610(16)30367-1/abstract
 

Sentinel Node Mapping Using a Fluorescent Dye and Visible Light During Laparoscopic Gastrectomy for Early Gastric Cancer: Result of a Prospective Study From a Single Institute

Lee, Chang Min MD, PhD; Park, Sungsoo MD, PhD; Park, Seong-Heum MD, PhD; Jung, Sung Woo MD, PhD; Choe, Jung Wan MD; Sul, Ji-Young MD, PhD; Jang, You Jin MD, PhD; Mok, Young-Jae MD, PhD; Kim, Jong-Han MD, PhD

Annals of Surgery: April 2017 - Volume 265 - Issue 4 - p 766–773

doi: 10.1097/SLA.0000000000001739

Original Articles

Objective: The aim of this study was to investigate the feasibility of sentinel node mapping using a fluorescent dye and visible light in patients with gastric cancer.

Background: Recently, fluorescent imaging technology offers improved visibility with the possibility of better sensitivity or accuracy in sentinel node mapping.

Methods: Twenty patients with early gastric cancer, for whom laparoscopic distal gastrectomy with standard lymphadenectomy had been planned, were enrolled in this study. Before lymphadenectomy, the patients received a gastrofiberoscopic peritumoral injection of fluorescein solution. The sentinel basin was investigated via laparoscopic fluorescent imaging under blue light (wavelength of 440–490 nm) emitted from an LED curing light. The detection rate and lymph node status were analyzed in the enrolled patients. In addition, short-term clinical outcomes were also investigated.

Results: No hypersensitivity to the dye was identified in any enrolled patients. Sentinel nodes were detected in 19 of 20 enrolled patients (95.0%), and metastatic lymph nodes were found in 2 patients. The latter lymph nodes belonged to the sentinel basin of each patient. Meanwhile, 1 patient (5.0%) experienced a postoperative complication that was unrelated to sentinel node mapping. No mortality was recorded among enrolled cases.

Conclusions: Sentinel node mapping with visible light fluorescence was a feasible method for visualizing sentinel nodes in patients with early gastric cancer. In addition, this method is advantageous in terms of visualizing the concrete relationship between the sentinel nodes and surrounding structures.

http://journals.lww.com/annalsofsurgery/Abstract/2017/04000/Sentinel_Node_Mapping_Using_a_Fluorescent_Dye_and.24.aspx