A Novel Prediction Model of Prognosis After Gastrectomy for Gastric Carcinoma: Development and Validation Using Asian Databases

Woo, Yanghee MD; Son, Taeil MD; Song, Kijun PhD; Okumura, Naoki MD; Hu, Yanfeng MD; Cho, Gyu-Seok MD; Kim, Jong Won MD; Choi, Seung-Ho MD; Noh, Sung Hoon MD; Hyung, Woo Jin MD, PhD

Annals of Surgery: July 2016 - Volume 264 - Issue 1 - p 114–120

doi: 10.1097/SLA.0000000000001523

Original Articles

Objective: The prognoses of gastric cancer patients vary greatly among countries. Meanwhile, tumor-node-metastasis (TNM) staging system shows limited accuracy in predicting patient-specific survival for gastric cancer. The objective of this study was to create a simple, yet universally applicable survival prediction model for surgically treated gastric cancer patients.

Summary Background Data: A prediction model of 5-year overall survival for surgically treated gastric cancer patients regardless of curability was developed using a test data set of 11,851 consecutive patients.

Methods: The model's coefficients were selected based on univariate and multivariate analysis of patient, tumor, and surgical factors shown to significantly impact survival using a Cox proportional hazards model. For internal validation, discrimination was calculated with the concordance index (C-statistic) using the bootstrap method and calibration assessed. The model was externally validated using 4 data sets from 3 countries.

Results: Our model's C-statistic (0.824) showed better discrimination power than current tumor-node-metastasis staging (0.788) (P < 0.0001). Bootstrap internal validation demonstrated that coefficients remained largely unchanged between iterations, with an average C-statistic of 0.822. The model calibration was accurate in predicting 5-year survival. In the external validation, C-statistics showed good discrimination (range: 0.798–0.868) in patient data sets from 4 participating institutions in 3 different countries.

Conclusions: Utilizing clinically practical patient, tumor, and surgical information, we developed a universally applicable prediction model for accurately determining the 5-year overall survival of gastric cancer patients after gastrectomy. Our predictive model was also valid in patients who underwent noncurative resection or inadequate lymphadenectomy.

http://journals.lww.com/annalsofsurgery/Abstract/2016/07000/A_Novel_Prediction_Model_of_Prognosis_After.19.aspx

Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A Systematic Review and Meta-analysis

Willcutts, Kate F. DCN, RD; Chung, Mei C. PhD, MPH; Erenberg, Cheryl L. MLS; Finn, Kristen L. DCN, RD; Schirmer, Bruce D. MD; Byham-Gray, Laura D. PhD, RD

Annals of Surgery: July 2016 - Volume 264 - Issue 1 - p 54–63

doi: 10.1097/SLA.0000000000001644

Meta-Analyses

Objective: To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes.

Background: Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery.

Results: Fifteen studies comprising 2112 adult patients met all the inclusion criteria. Mean hospital stay was significantly shorter in the early-fed group than in the late-fed group [weighted mean difference = −1.72 d, 95% confidence interval (CI) −1.25 to −2.20, P < 0.01). Postoperative length of stay was also significantly shorter (weighted mean difference = −1.44 d, 95% CI −0.68 to −2.20, P < 0.01). There was no significant difference in risk of anastomotic leak, pneumonia, nasogastric tube reinsertion, reoperation, readmission, or mortality in the randomized controlled trials (RCTs). The pooled RCT and non-RCT results, however, showed a significantly lower risk of pneumonia in early-fed as compared with late-fed group (odds ratio = 0.6, 95% CI 0.41–0.89, P = 0.01).

Conclusions: Early postoperative oral feeding as compared with traditional (or late) timing is associated with shorter hospital length of stay and is not associated with an increase in clinically relevant complications.

http://journals.lww.com/annalsofsurgery/Abstract/2016/07000/Early_Oral_Feeding_as_Compared_With_Traditional.11.aspx