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  1. Article ; Online: OSATS scoring confirms ICG enhancement of performance in laparoscopic radical gastrectomy: a post-hoc analysis of a randomized controlled trial.

    Huang, Ze-Ning / He, Qi-Chen / Qiu, Wen-Wu / Wu, Ju / Zheng, Chang-Yue / Lin, Guo-Sheng / Li, Ping / Wang, Jia-Bin / Lin, Jian-Xian / Lu, Jun / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Zheng, Chao-Hui / Chen, Qi-Yue / Huang, Chang-Ming / Xie, Jian-Wei

    International journal of surgery (London, England)

    2024  Volume 110, Issue 1, Page(s) 342–352

    Abstract: Background: Indocyanine green (ICG) fluorescence imaging is effective in increasing the number of lymph node dissections during laparoscopic radical gastrectomy; however, no studies have attempted to explain this phenomenon.: Methods: This study ... ...

    Abstract Background: Indocyanine green (ICG) fluorescence imaging is effective in increasing the number of lymph node dissections during laparoscopic radical gastrectomy; however, no studies have attempted to explain this phenomenon.
    Methods: This study utilized the data from a previous randomized controlled trial (FUGES-012 study) investigating ICG-guided laparoscopic radical gastrectomy performed between November 2018 and July 2019. The Objective Structured Assessments of Technical Skills (OSATS) scoring system was used to grade videos from the ICG and non-ICG groups. Patients with an OSATS score greater than 29 were classified as the high-OSATS population, while those with an OSATS score less than or equal to 29 were classified as the low-OSATS population.
    Results: A total of 258 patients were included in the modified intention-to-treat analysis: 129 in the ICG group and 129 in the non-ICG group. The OSATS score of the ICG group was higher than that of the non-ICG group (29.6±2.6 vs. 26.6±3.6; P <0.001). The ICG group underwent a significantly higher mean total number of lymph node dissections than the non-ICG group (50.5±15.9 vs. 42.0±10.3; adjusted P <0.001). The group assigned to ICG use, better OSATS (high-OSATS) scores were observed, which correlated with greater D2 lymph node retrieval (54.1±15.0 vs. 47.2±8.7; adjusted P =0.039). Finally, the ICG group had a lower rate of lymph node noncompliance than that of the non-ICG group (31.8 vs. 57.4%; P <0.001).
    Conclusions: By applying the ICG fluorescence navigation technique, better OSATS scores were observed, which correlated with greater lymph node retrieval and a lower lymph node noncompliance rate, as recommended for individualized laparoscopic radical gastrectomy.
    MeSH term(s) Humans ; Indocyanine Green ; Stomach Neoplasms/surgery ; Stomach Neoplasms/pathology ; Lymph Node Excision/methods ; Lymph Nodes/pathology ; Laparoscopy/methods ; Gastrectomy/methods ; Sentinel Lymph Node Biopsy/methods
    Chemical Substances Indocyanine Green (IX6J1063HV)
    Language English
    Publishing date 2024-01-01
    Publishing country United States
    Document type Randomized Controlled Trial ; Journal Article
    ZDB-ID 2212038-5
    ISSN 1743-9159 ; 1743-9191
    ISSN (online) 1743-9159
    ISSN 1743-9191
    DOI 10.1097/JS9.0000000000000830
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  2. Article ; Online: Laparoscopic Spleen-Preserving Hilar Lymphadenectomy for Advanced Proximal Gastric Cancer Without Greater Curvature Invasion: Five-Year Outcomes From the Fuges-02 Randomized Clinical Trial.

    Lin, Jian-Xian / Xu, Bin-Bin / Zheng, Hua-Long / Li, Ping / Xie, Jian-Wei / Wang, Jia-Bin / Lu, Jun / Chen, Qi-Yue / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Huang, Ze-Ning / Lin, Ju-Li / Yao, Zi-Hao / Zheng, Chao-Hui / Huang, Chang-Ming

    JAMA surgery

    2024  

    Abstract: Importance: Splenic hilar lymphadenectomy has been recommended for locally advanced proximal gastric cancer (APGC) involving the greater curvature. However, it is unclear whether laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) is ... ...

    Abstract Importance: Splenic hilar lymphadenectomy has been recommended for locally advanced proximal gastric cancer (APGC) involving the greater curvature. However, it is unclear whether laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPSHL) is associated with a long-term survival benefit for APGC without greater curvature invasion.
    Objective: To present the 5-year follow-up data from a randomized clinical trial that compared laparoscopic total gastrectomy (D2 group) with D2 plus LSPSHL (D2 + No. 10 group) among patients with resectable APGC.
    Design, setting, and participants: This is a post hoc secondary analysis of a randomized clinical trial that enrolled 536 patients with potentially resectable APGC (cT2-4a, N0 or N+, and M0) without greater curvature invasion from January 5, 2015, to October 10, 2018. All patients were tracked for at least 5 years. The final follow-up was on October 30, 2023.
    Interventions: Patients were randomly assigned in a 1:1 ratio to the D2 + No. 10 or D2 groups.
    Main outcomes and measures: The 5-year disease-free survival (DFS) and overall survival (OS) rates were measured. Recurrence patterns and causes of death were compared.
    Results: A total of 526 patients (392 men [74.5%]; mean [SD] age, 60.6 [9.6] years) were included in the modified intent-to-treat analysis, with 263 patients in each group. The 5-year DFS rate was 63.9% (95% CI, 58.1%-69.7%) for the D2 + No. 10 group and 55.1% (95% CI, 49.1%-61.1%) for the D2 group (log-rank P = .04). A statistically significant difference was observed in the 5-year OS between the D2 + No. 10 group and the D2 group (66.2% [95% CI, 60.4%-71.9%] vs 57.4% [95% CI, 51.4%-63.4%]; log-rank P = .03). The No. 10 lymph node exhibited a therapeutic value index (TVI) of 6.5, surpassing that of Nos. 8a (TVI, 3.0), 11 (TVI, 5.8), and 12a (TVI, 0.8). A total of 86 patients in the D2 + No. 10 group (cumulative incidence, 32.7%) and 111 patients in the D2 group (cumulative incidence, 42.2%) experienced recurrence (hazard ratio, 0.72; 95% CI, 0.54-0.95; P = .02). The multivariable competing risk regression model demonstrated that D2 + No. 10 remained an independent protective factor for a lower 5-year cumulative recurrence rate after surgery (hazard ratio, 0.75; 95% CI, 0.56-1.00; P = .05). There was a significant difference in the 5-year cumulative recurrence rate at the No. 10 lymph node area between the 2 groups (D2 + No. 10 group vs D2 group: 0% vs 2.3% [n = 6]; P = .01).
    Conclusions: This post hoc secondary analysis of a randomized clinical trial found that laparoscopic total gastrectomy with LSPSHL can improve the prognosis and reduce recurrence for APGC without greater curvature invasion. Future multicenter studies are warranted to validate these findings.
    Trial registration: ClinicalTrials.gov Identifier: NCT02333721.
    Language English
    Publishing date 2024-05-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2024.1023
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  3. Article ; Online: Assessment of Laparoscopic Indocyanine Green Tracer-guided Lymphadenectomy After Neoadjuvant Chemotherapy for Locally Advanced Gastric Cancer: A Randomized Controlled Trial.

    Huang, Ze-Ning / Tang, Yi-Hui / Zhong, Qing / Li, Ping / Xie, Jian-Wei / Wang, Jia-Bin / Lin, Jian-Xian / Lu, Jun / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Zheng, Chao-Hui / Chen, Qi-Yue / Huang, Chang-Ming

    Annals of surgery

    2024  Volume 279, Issue 6, Page(s) 923–931

    Abstract: Objective: To assess the effectiveness of indocyanine green (ICG)-guided lymph node (LN) dissection during laparoscopic radical gastrectomy after neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC).: Background: ... ...

    Abstract Objective: To assess the effectiveness of indocyanine green (ICG)-guided lymph node (LN) dissection during laparoscopic radical gastrectomy after neoadjuvant chemotherapy (NAC) in patients with locally advanced gastric cancer (LAGC).
    Background: Studies on ICG imaging use in patients with LAGC on NAC are rare.
    Methods: Patients with gastric adenocarcinoma (clinical T2-4NanyM0) who received NAC were randomly assigned to receive ICG-guided laparoscopic radical gastrectomy or laparoscopic radical gastrectomy alone. Here, we reported the secondary endpoints including the quality of lymphadenectomy (total retrieved LNs and LN noncompliance) and surgical outcomes.
    Results: Overall, 240 patients were randomized. Of whom, 236 patients were included in the primary analysis (118 in the ICG group and 118 in the non-ICG group). In the ICG group, the mean number of LNs retrieved was significantly higher than in the non-ICG group within the D2 dissection (48.2 vs 38.3, P < 0.001). The ICG fluorescence guidance significantly decreased the LN noncompliance rates (33.9% vs 55.1%, P = 0.001). In 165 patients without baseline measurable LNs, ICG significantly increased the number of retrieved LNs and decreased the LN noncompliance rate ( P < 0.05). For 71 patients with baseline measurable LNs, the quality of lymphadenectomy significantly improved in those who had a complete response ( P < 0.05) but not in those who did not ( P > 0.05). Surgical outcomes were comparable between the groups ( P > 0.05).
    Conclusions: ICG can effectively improve the quality of lymphadenectomy in patients with LAGC who underwent laparoscopic radical gastrectomy after NAC.
    MeSH term(s) Humans ; Indocyanine Green/administration & dosage ; Stomach Neoplasms/surgery ; Stomach Neoplasms/pathology ; Stomach Neoplasms/drug therapy ; Lymph Node Excision/methods ; Male ; Laparoscopy/methods ; Female ; Middle Aged ; Neoadjuvant Therapy ; Gastrectomy/methods ; Aged ; Adenocarcinoma/surgery ; Adenocarcinoma/drug therapy ; Adenocarcinoma/pathology ; Coloring Agents/administration & dosage ; Adult ; Treatment Outcome ; Neoplasm Staging ; Chemotherapy, Adjuvant
    Chemical Substances Indocyanine Green (IX6J1063HV) ; Coloring Agents
    Language English
    Publishing date 2024-02-20
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ZDB-ID 340-2
    ISSN 1528-1140 ; 0003-4932
    ISSN (online) 1528-1140
    ISSN 0003-4932
    DOI 10.1097/SLA.0000000000006242
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  4. Article ; Online: Laparoscopic radical gastrectomy for gastric cancer: Long-term outcome in a teaching center.

    Tu, Ru-Hong / Lin, Mi / Lin, Jian-Xian / Wu, Sheng-Ze / Xie, Jian-Wei / Wang, Jia-Bin / Lu, Jun / Chen, Qi-Yue / Cao, Long-Long / Zheng, Chao-Hui / Huang, Chang-Ming / Li, Ping

    Asian journal of surgery

    2023  Volume 47, Issue 1, Page(s) 459–465

    Abstract: Background: Laparoscopic gastrectomy for gastric cancer (GC) are increasing, yet the evidence of the relationship between the learning curve and long-term outcomes is limited.: Aims: To analyze the relationship between the learning curve and survival ...

    Abstract Background: Laparoscopic gastrectomy for gastric cancer (GC) are increasing, yet the evidence of the relationship between the learning curve and long-term outcomes is limited.
    Aims: To analyze the relationship between the learning curve and survival in GC patients over a 10-year period.
    Methods: This retrospective cohort study studied 3674 patients who underwent laparoscopic radical gastrectomy for gastric cancer. Cusum and Cox regression analysis were used to assess the association between the surgeon's experience and the 3 years overall survival (OS).
    Results: The 3-year OS of all patients was 71.8 %. This increase of 3-year OS was associated with laparoscopic cases (r = 0.638, p = 0.047). Analysis of the CUSUM curve showed a significant change in the 3-year OS of 1400 cases. Further propensity score matching (PSM) of patients during and after the learning curve (<1400 and ≥ 1400 cases) showed a significant difference in the 3-year OS between the two groups (68.5 % vs. 72.3 %, p = 0.045). Cox regression analysis verified that in ≥1400 cases, prior laparoscopic surgery (p = 0.045), textbook outcome (TO) and the number of retrieved lymph nodes (LNs) were independent protective factors. The LN non-compliance rate was an independent risk factor. In contrast, the rate of TO and the median number of retrieved LNs were significantly higher after the learning curve (≥1400 cases). Furthermore, the rates of LN non-compliance were significantly lower (p < 0.05).
    Conclusions: Increasing laparoscopic surgical experience is associated with surgical quality and prognostic improvement in patients with gastric cancer. But improvements in outcomes accrued slowly over a long period.
    MeSH term(s) Humans ; Retrospective Studies ; Lymph Node Excision ; Stomach Neoplasms/pathology ; Laparoscopy ; Gastrectomy ; Propensity Score ; Treatment Outcome
    Language English
    Publishing date 2023-10-23
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1068461-x
    ISSN 0219-3108 ; 1015-9584
    ISSN (online) 0219-3108
    ISSN 1015-9584
    DOI 10.1016/j.asjsur.2023.10.002
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  5. Article ; Online: Textbook oncological outcomes and prognosis after curative gastrectomy in advanced gastric cancer: A multicenter study.

    Huang, Ze-Ning / Zheng, Chang-Yue / Wu, Ju / Tang, Yi-Hui / Qiu, Wen-Wu / He, Qi-Chen / Lin, Guo-Sheng / Chen, Qi-Yue / Lu, Jun / Wang, Jia-Bin / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Xie, Jian-Wei / Li, Ping / Lin, Wei / Huang, Chang-Ming / Lin, Jian-Xian / Zheng, Chao-Hui

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2024  Volume 50, Issue 6, Page(s) 108280

    Abstract: Background: The impact of achieving textbook oncological outcome (TOO) as a multimodal therapy quality indicator on the prognosis of advanced gastric cancer (AGC) remains inadequately assessed.: Methods: Patients with AGC who underwent curative ... ...

    Abstract Background: The impact of achieving textbook oncological outcome (TOO) as a multimodal therapy quality indicator on the prognosis of advanced gastric cancer (AGC) remains inadequately assessed.
    Methods: Patients with AGC who underwent curative gastrectomy between January 2010 and December 2017 at two East Asian medical centers were included. TOO was defined as achieving the textbook outcome (TO) and receiving neoadjuvant and/or adjuvant chemotherapy (NCT or ACT). Cox and logistic regression models were used to identify prognostic and non-TOO-associated risk factors.
    Results: Among 3626 patients, 57.6% achieved TOO (TOO group), exhibiting significantly better 5-year overall survival (OS) and disease-free survival (DFS) than the non-TOO group (both p < 0.05). Multivariate Cox regression identified TOO as an independent prognostic factor for 5-year OS (HR, 0.67; 95% CI, 0.61-0.74; p < 0.001) and DFS (HR, 0.73; 95% CI, 0.66-0.81; p < 0.001). Multivariate logistic regression showed that open gastrectomy, lack of health insurance, age ≥65 years, ASA score ≥ Ⅲ, and tumor size ≥50 mm are independent risk factors for non-achievement of TOO (all p < 0.05). On a sensitivity analysis of TOO's prognostic value using varying definitions of chemotherapy parameters, a stricter definition of chemotherapy resulted in a decrease in the TOO achievement rate from 57.6 to 22.3%. However, the associated reductions in the risk of death and recurrence fluctuated within the ranges of 33-39% and 28-37%, respectively.
    Conclusions: TOO is a reliable and stable metric for favorable prognosis in AGC. Optimizing the surgical approach and improving health insurance status may enhance TOO achievement.
    Language English
    Publishing date 2024-03-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2024.108280
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  6. Article ; Online: Correction: UFM1 suppresses invasive activities of gastric cancer cells by attenuating the expression of PDK1 through PI3K/AKT signaling.

    Lin, Jian-Xian / Xie, Xin-Sheng / Weng, Xiong-Feng / Qiu, Sheng-Liang / Yoon, Changhwan / Lian, Ning-Zi / Xie, Jian-Wei / Wang, Jia-Bin / Lu, Jun / Chen, Qi-Yue / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Yang, Ying-Hong / Huang, Chang-Ming / Zheng, Chao-Hui / Li, Ping

    Journal of experimental & clinical cancer research : CR

    2023  Volume 42, Issue 1, Page(s) 307

    Language English
    Publishing date 2023-11-21
    Publishing country England
    Document type Published Erratum
    ZDB-ID 803138-1
    ISSN 1756-9966 ; 0392-9078
    ISSN (online) 1756-9966
    ISSN 0392-9078
    DOI 10.1186/s13046-023-02896-7
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  7. Article ; Online: Neurotransmitter Receptor HTR2B Regulates Lipid Metabolism to Inhibit Ferroptosis in Gastric Cancer.

    Tu, Ru-Hong / Wu, Sheng-Ze / Huang, Ze-Ning / Zhong, Qing / Ye, Yin-Hua / Zheng, Chao-Hui / Xie, Jian-Wei / Wang, Jia-Bin / Lin, Jian-Xian / Chen, Qi-Yue / Huang, Chang-Ming / Lin, Mi / Lu, Jun / Cao, Long-Long / Li, Ping

    Cancer research

    2023  Volume 83, Issue 23, Page(s) 3868–3885

    Abstract: Nerves can support tumor development by secreting neurotransmitters that promote cancer cell proliferation and invasion. 5-Hydroxytryptamine (5-HT) is a critical neurotransmitter in the gastrointestinal nervous system, and 5-HT signaling has been shown ... ...

    Abstract Nerves can support tumor development by secreting neurotransmitters that promote cancer cell proliferation and invasion. 5-Hydroxytryptamine (5-HT) is a critical neurotransmitter in the gastrointestinal nervous system, and 5-HT signaling has been shown to play a role in tumorigenesis. Here, we found that expression of the 5-HT receptor HTR2B was significantly elevated in human gastric adenocarcinoma tissues compared with nontumor tissues, and high HTR2B expression corresponded to shorter patient survival. Both 5-HT and a specific HTR2B agonist enhanced gastric adenocarcinoma cell viability under metabolic stress, reduced cellular and lipid reactive oxygen species, and suppressed ferroptosis; conversely, HTR2B loss or inhibition with a selective HTR2B antagonist yielded the inverse tumor suppressive effects. In a patient-derived xenograft tumor model, HTR2B-positive tumors displayed accelerated growth, which was inhibited by HTR2B antagonists. Single-cell analysis of human gastric adenocarcinoma tissues revealed enrichment of PI3K/Akt/mTOR and fatty acid metabolism-related gene clusters in cells expressing HTR2B compared with HTR2B-negative cells. Mechanistically, HTR2B cooperated with Fyn to directly regulate p85 activity and trigger the PI3K/Akt/mTOR signaling pathway, which led to increased expression of HIF1α and ABCD1 along with decreased levels of lipid peroxidation and ferroptosis. Together, these findings demonstrate that HTR2B activity modulates PI3K/Akt/mTOR signaling to stimulate gastric cancer cell survival and indicate that HTR2B expression could be a potential prognostic biomarker in patients with gastric cancer.
    Significance: Nerve cancer cross-talk mediated by HTR2B inhibits lipid peroxidation and ferroptosis in gastric cancer cells and promotes viability under metabolic stress, resulting in increased tumor growth and decreased patient survival.
    MeSH term(s) Humans ; Adenocarcinoma ; Cell Line, Tumor ; Cell Proliferation/genetics ; Ferroptosis ; Lipid Metabolism ; Phosphatidylinositol 3-Kinases/metabolism ; Proto-Oncogene Proteins c-akt/metabolism ; Receptors, Neurotransmitter/metabolism ; Serotonin/metabolism ; Serotonin/pharmacology ; Stomach Neoplasms/pathology ; TOR Serine-Threonine Kinases/metabolism
    Chemical Substances Phosphatidylinositol 3-Kinases (EC 2.7.1.-) ; Proto-Oncogene Proteins c-akt (EC 2.7.11.1) ; Receptors, Neurotransmitter ; Serotonin (333DO1RDJY) ; TOR Serine-Threonine Kinases (EC 2.7.11.1) ; HTR2B protein, human
    Language English
    Publishing date 2023-11-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1432-1
    ISSN 1538-7445 ; 0008-5472
    ISSN (online) 1538-7445
    ISSN 0008-5472
    DOI 10.1158/0008-5472.CAN-23-1012
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  8. Article ; Online: The peroxisome proliferator-activated receptor agonist rosiglitazone specifically represses tumour metastatic potential in chromatin inaccessibility-mediated FABP4-deficient gastric cancer.

    Chen, Qi-Yue / Huang, Xiao-Bo / Zhao, Ya-Jun / Wang, Hua-Gen / Wang, Jia-Bin / Liu, Li-Chao / Wang, Ling-Qian / Zhong, Qing / Xie, Jian-Wei / Lin, Jian-Xian / Lu, Jun / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Zheng, Chao-Hui / Li, Ping / Huang, Chang-Ming

    Theranostics

    2022  Volume 12, Issue 4, Page(s) 1904–1920

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Animals ; Chromatin ; Disease Models, Animal ; Fatty Acid-Binding Proteins/genetics ; Humans ; Hypoglycemic Agents/pharmacology ; Mice ; PPAR gamma/metabolism ; Rosiglitazone/pharmacology ; Stomach Neoplasms/drug therapy ; Stomach Neoplasms/genetics ; Thiazolidinediones/therapeutic use
    Chemical Substances Chromatin ; FABP4 protein, human ; Fabp4 protein, mouse ; Fatty Acid-Binding Proteins ; Hypoglycemic Agents ; PPAR gamma ; Thiazolidinediones ; Rosiglitazone (05V02F2KDG)
    Language English
    Publishing date 2022-01-24
    Publishing country Australia
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2592097-2
    ISSN 1838-7640 ; 1838-7640
    ISSN (online) 1838-7640
    ISSN 1838-7640
    DOI 10.7150/thno.66814
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  9. Article ; Online: Association of Adjuvant Chemotherapy With Overall Survival Among Patients With Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy.

    Lin, Jian-Xian / Tang, Yi-Hui / Lin, Guan-Jie / Ma, Yu-Bin / Desiderio, Jacopo / Li, Ping / Xie, Jian-Wei / Wang, Jia-Bin / Lu, Jun / Chen, Qi-Yue / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Zheng, Chao-Hui / Parisi, Amilcare / Truty, Mark J / Huang, Chang-Ming

    JAMA network open

    2022  Volume 5, Issue 4, Page(s) e225557

    Abstract: Importance: Neoadjuvant chemotherapy (NAC) is a standard treatment option for locally advanced gastric cancer (LAGC); however, the indications for adjuvant chemotherapy (AC) in patients with LAGC who received NAC remain controversial.: Objective: To ... ...

    Abstract Importance: Neoadjuvant chemotherapy (NAC) is a standard treatment option for locally advanced gastric cancer (LAGC); however, the indications for adjuvant chemotherapy (AC) in patients with LAGC who received NAC remain controversial.
    Objective: To compare survival rates between patients with LAGC who received AC and those who did not after NAC followed by surgery.
    Design, setting, and participants: This multicenter, international cohort study included 353 patients with LAGC undergoing curative-intent gastrectomy after NAC at 2 tertiary referral teaching hospitals in China between June 1, 2008, and December 31, 2017. To externally validate the findings in the Chinese patients, 109 patients from the US and Italy between June 1, 2006, and June 30, 2013, were reviewed. The follow-up period of the Chinese patients was completed in December 2020, and the follow-up period of the Western patients was completed between February and July 2017. Data analysis was performed from December 1, 2020, to February 28, 2021.
    Exposures: Patients who received AC and those who did not were propensity score matched to evaluate the association of AC with survival.
    Main outcomes and measures: Overall survival (OS), disease-free survival, and disease-specific survival.
    Results: Of 353 patients from China (275 [78.1%] male; mean [SD] age, 58.0 [10.7] years), 262 (74.1%) received AC and 91 (25.9%) did not. After propensity score matching, the 3-year OS was significantly higher in patients who received AC (60.1%; 95% CI, 53.1%-68.1%) than in those who did not (49.3%; 95% CI, 39.8%-61.0%) (P = .02). Lymph node ratio (LNR) was significantly associated with AC benefit (P < .001 for interaction), and a plot of the interaction between LNR and AC demonstrated that AC was associated with improved OS in patients with higher (≥9%) LNRs (3-year OS: 46.6% vs 21.7%; P < .001), but not in patients with LNRs less than 9% (3-year OS: 73.9% vs 71.3%; P = .30). When stratified by AC cycles, only those patients who completed at least 4 AC cycles exhibited a significant survival benefit in the 6-month (hazard ratio, 0.56; 95% CI, 0.33-0.96; P = .03) and 9-month landmark analysis (hazard ratio, 0.50; 95% CI, 0.27-0.94; P = .03). In the external cohort, improved OS with AC administration was also found in patients with LNRs of 9% or greater (3-year OS: 53.0% vs 26.3%; P = .04).
    Conclusions and relevance: In this cohort study, the administration of AC after NAC and resection of LAGC was associated with improved prognosis in patients with LNRs of 9% or greater. These findings suggest that LNR might be valuable in AC selection in future decision-making processes.
    MeSH term(s) Chemotherapy, Adjuvant ; Cohort Studies ; Humans ; Male ; Middle Aged ; Neoadjuvant Therapy ; Prognosis ; Stomach Neoplasms/drug therapy
    Language English
    Publishing date 2022-04-01
    Publishing country United States
    Document type Journal Article ; Multicenter Study
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.5557
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: A national advanced training program for laparoscopic radical gastrectomy has a positive impact on surgical trainees: A before and after study (ATP-LRG-1).

    Wang, Zu-Kai / Lin, Jian-Xian / Huang, Jiao-Bao / Lu, Jun / Huang, Ze-Ning / Xie, Jian-Wei / Wang, Jia-Bin / Chen, Qi-Yue / Cao, Long-Long / Lin, Mi / Tu, Ru-Hong / Lin, Ju-Li / Zheng, Hua-Long / Li, Ping / Zheng, Chao-Hui / Huang, Chang-Ming

    International journal of surgery (London, England)

    2022  Volume 104, Page(s) 106781

    Abstract: Background: Due to the high technical requirements of laparoscopic radical gastrectomy (LRG), establishing an effective training system to promote clinical technology and operation specifications is necessary. We aimed to evaluate the effect of a ... ...

    Abstract Background: Due to the high technical requirements of laparoscopic radical gastrectomy (LRG), establishing an effective training system to promote clinical technology and operation specifications is necessary. We aimed to evaluate the effect of a national advanced training program for LRG (ATP-LRG).
    Materials and methods: The contents of the training include the following: 1) detailed technique descriptions; 2) prevention and solving of intraoperative complications; 3) live surgery performance; 4) theory and practice of clinical research; 5) comments on trainees' videos; and 6) questions, answers, and discussions. This retrospective before and after study surveyed 875 trainees from January 2015 to October 2020. Endpoints were general surgical skills (GSS), laparoscopic gastrectomy acceptance (LGA), and clinical research possibilities (CRP). The analysis took place in December 2021.
    Results: The response rate was 70.5% (617/875). ATP-LRG reportedly had a positive impact on the LRG practice of 99.5% (614/617) of trainees. Their GSS (before vs. after: 16.5 ± 3.7 vs. 20.3 ± 3.1, P < 0.001), LGA (4.2 ± 0.9 vs. 4.6 ± 0.7, P < 0.001), and CRP (2.6 ± 1.2 vs. 3.2 ± 1.1, P < 0.001) significantly improved. The improvement in GSS for those with professional titles of associate chief surgeons and below was significantly higher than that for chief surgeons (4.0 ± 3.0 vs 3.3 ± 2.4, P = 0.017), while those of LGA and CRP were not. The annual number of operations before training was negatively correlated with improvement in GSS (P < 0.001, Pearson's correlation coefficient: 0.14). Multivariate logistic regression showed that those with professional titles of associate chief surgeons and below (odds ratio [OR]: 1.719, 95% confidence interval [CI]: 1.038-2.846, P = 0.035), and with annual number of operations before training being <60, (OR: 5.257, 95% CI: 2.573-10.742, P < 0.001) were most prone to high-GSS improvement.
    Conclusion: The nationwide ATP-LRG facilitates the improvement of trainees' GSS, LGA, and CRP levels. Surgeons with lower professional titles and fewer performed operations are most likely to improve their GSS through training.
    MeSH term(s) Adenosine Triphosphate ; Clinical Competence ; Gastrectomy ; Humans ; Laparoscopy ; Retrospective Studies ; Surgeons
    Chemical Substances Adenosine Triphosphate (8L70Q75FXE)
    Language English
    Publishing date 2022-08-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2212038-5
    ISSN 1743-9159 ; 1743-9191
    ISSN (online) 1743-9159
    ISSN 1743-9191
    DOI 10.1016/j.ijsu.2022.106781
    Database MEDical Literature Analysis and Retrieval System OnLINE

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