Ongoing clinical studies of minimally invasive surgery for gastric cancer in Japan

Abstract

Since the development of laparoscopy-assisted distal gastrectomy (LADG) with lymph node dissection for gastric cancer in Japan, this type of surgery is improving and evolving. To establish high-quality evidence of laparoscopic gastrectomy (LAG) in the field of gastric cancer treatments, two large-scale, prospective randomized controlled trials have been performed in Japan; the Japan Clinical Oncology Study Group (JCOG) 0912 for early disease and the Japanese Laparoscopic Surgery Study Group (JLSSG) 0901 for advanced disease. Analyses using mega-data from the National Clinical Database (NCD) have also been carried out as a clinical study to clarify the safety of LAG. Furthermore, as advanced laparoscopic techniques have been developed, prospective clinical studies are being performed with regard to laparoscopy-assisted total gastrectomy (LATG), robotic gastrectomy, and minimally invasive surgery with sentinel node (SN) navigation. This review summarizes the current status of minimally invasive surgeries for gastric cancer based on the latest ongoing clinical trials in Japan.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244702/

Long-term Quality of Life After Distal Subtotal and Total Gastrectomy: Symptom- and Behavior-oriented Consequences

Lee, Seung Soo MD; Chung, Ho Young MD, PhD; Kwon, Oh Kyoung MD; Yu, Wansik MD, PhD

Annals of Surgery: April 2016 - Volume 263 - Issue 4 - p 738–744

doi: 10.1097/SLA.0000000000001481

Original Articles

Objective: This study assessed long-term quality of life (QoL) after subtotal gastrectomy (STG) and total gastrectomy (TG) by comparing groups matched by a set of patient factors at and beyond postoperative 5 years. The cause of QoL gaps based on symptomatic and behavioral consequences of surgery were investigated.

Methods: The European Organization for Research and Treatment of Cancer QoL Questionnaire (QLQ)-C30 and QLQ-STO22 were used to assess QoL. QoL comparisons between STG and TG groups were made for 5-year survivors and long-term survivors.

Results: Five-year survivors after TG showed significantly worse QoL in social functioning, nausea and vomiting, eating restrictions, and taste. For long-term survivors, QoL inferiority of the TG group was observed only in eating restrictions. Among 4 items constituting eating restrictions, the TG group tended to exhibit worse QoL in 2 items (enjoyable meals and social meals).

Conclusions: Although 5-year survivors after TG still suffer from QoL inferiority from symptomatic and behavioral consequences of surgery, inferiority from behavioral consequences will persist even after symptomatic inferiority to STG survivors is no longer valid. Efforts to ameliorate persistent QoL inferiority in TG survivors should be directed toward restoring dietary behaviors, where TG survivors are prevented from enjoyable meals and social meals.

http://journals.lww.com/annalsofsurgery/Abstract/2016/04000/Long_term_Quality_of_Life_After_Distal_Subtotal.16.aspx

Surgeon Volume and Cancer Esophagectomy, Gastrectomy, and Pancreatectomy: A Population-based Study in England

Mamidanna, Ravikrishna MRCS; Ni, Zhifang MSc, PhD; Anderson, Oliver BSc, MSc, MRCS; Spiegelhalter, Sir David PhD; Bottle, Alex PhD; Aylin, Paul; Faiz, Omar MS, FRCS; Hanna, George B. PhD, FRCS

Annals of Surgery: April 2016 - Volume 263 - Issue 4 - p 727–732

doi: 10.1097/SLA.0000000000001490

Original Articles

Objective: The aim of the study was to assess whether there is a proficiency curve-like relationship between surgeon volume and operative mortality and determine the minimum surgeon volume for optimum operative mortality.

Background: The inverse relationship between hospital volume and operative mortality is well-established for esophageal, gastric, and pancreatic cancer. The recommended minimum surgeon volumes are however uncertain.

Results: Sixteen thousand five hundred seventy-two esophagectomies, 12,622 gastrectomies, and 9116 pancreatectomies were examined. Surgeon volume ranged from 2 to 29 esophagectomies, from 1 to 14 gastrectomies, and from 2 to 31 pancreatectomies per surgeon per year. We demonstrated a proficiency relationship between surgeon volume and mortality in esophageal, gastric, and pancreatic cancer surgery. Each additional case of esophagectomy, gastrectomy, and pancreatectomy would reduce 30-day mortality odds by 3.4%, 7.2%, and 4.1%, respectively. However, as surgeon volume increased, mortality rate continued to improve. Therefore, we were unable to recommend minimum surgeon volume.

Conclusions: Mortality after resections for esophageal, gastric, and pancreatic cancer falls as surgeon volume rises up to 30 cases. Within this range, we did not demonstrate any statistical threshold that could be recommended as a minimum volume target.

http://journals.lww.com/annalsofsurgery/Abstract/2016/04000/Surgeon_Volume_and_Cancer_Esophagectomy,.14.aspx