Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 9/2023

16-06-2023 | CT Angiography

Short- and long-term outcomes of laparoscopic or robotic radical gastrectomy based on preoperative perigastric artery CTA surgical decision-making: a high-volume center retrospective study with propensity score matching

Authors: Cheng Meng, Shougen Cao, Yulong Tian, Shuai Shen, Xiaodong Liu, Zequn Li, Yu Li, Yuqi Sun, Jianfei Xu, Xingqi Zhang, Ying Kong, Xujie Wang, Hao Yang, Hao Zhong, Zhuoyu Jia, Dongfeng Zhang, Yanbing Zhou

Published in: Surgical Endoscopy | Issue 9/2023

Login to get access

Abstract

Background

Some studies have demonstrated the short-term recovery course for patients who underwent laparoscopic gastrectomy according to preoperative computed tomography angiography (CTA) assessment. However, reports of the long-term oncological outcomes are still limited.

Methods

The data of 988 consecutive patients who underwent laparoscopic or robotic radical gastrectomy between January 2014 and September 2018 were analyzed retrospectively at our center, and propensity score matching was used to eliminate bias. Study cohorts were divided into the CTA group (n = 498) and the non-CTA group (n = 490) depending on whether preoperative CTA was available. The primary and secondary endpoints were the 3-year overall survival (OS) and disease-free survival (DFS) rates and the intraoperative course and short-term outcomes, respectively.

Results

431 patients were included in each group after PSM. Compared with the non-CTA group, the CTA group had more harvested lymph nodes and less operative time, blood loss, intraoperative vascular injury and total cost, especially in the subgroup analysis with BMI ≥ 25 kg/m2 patients. There was no difference in the 3 year OS and DFS between the CTA group and the non-CTA group. When further stratified by BMI < 25 or ≥ 25 kg/m2, the 3-year OS and DFS were significantly higher in the CTA group than in the non-CTA group in terms of BMI ≥ 25 kg/m2.

Conclusions

Laparoscopic or robotic radical gastrectomy based on preoperative perigastric artery CTA surgical decision-making has the possibility of improving short-term outcomes. However, there is no difference in the long-term prognosis, except for a subgroup of patients with BMI ≥ 25 kg/m2.

Graphical abstract

Appendix
Available only for authorised users
Literature
1.
Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, Jemal A, Kramer JL, Siegel RL (2019) Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin 69:363–385CrossRefPubMed
2.
3.
Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357CrossRefPubMed
4.
Yu J, Huang C, Sun Y, Su X, Cao H, Hu J, Wang K, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Hu Y, Liu H, Zheng C, Li P, Xie J, Liu F, Li Z, Zhao G, Yang K, Liu C, Li H, Chen P, Ji J, Li G (2019) Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: the class-01 randomized clinical trial. JAMA 321:1983–1992CrossRefPubMedPubMedCentral
5.
Sunagawa H, Kinoshita T (2017) Three-dimensional computed tomography simulation for laparoscopic lymph node dissection in the treatment of proximal gastric cancer. Transl Gastroenterol Hepatol 2:54CrossRefPubMedPubMedCentral
6.
7.
Chen Y, Liu L, Wang X, Wang J, Yan Z, Cheng J, Gong G, Li G (2013) Body mass index and risk of gastric cancer: a meta-analysis of a population with more than ten million from 24 prospective studies. Cancer Epidemiol Biomark Prev 22:1395–1408CrossRef
8.
Dhar DK, Kubota H, Tachibana M, Kotoh T, Tabara H, Masunaga R, Kohno H, Nagasue N (2000) Body mass index determines the success of lymph node dissection and predicts the outcome of gastric carcinoma patients. Oncology 59:18–23CrossRefPubMed
9.
Tokunaga M, Hiki N, Fukunaga T, Ogura T, Miyata S, Yamaguchi T (2009) Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. J British Surg 96:496–500CrossRef
10.
11.
Surgery B (2016) Robotic and laparoscopic surgery Committee of Chin: Guideline for laparoscopic gastrectomy for gastric cancer (2016 edition). Chinese Journal of Digestive Surgery 15:851–857
12.
Japanese Gastric Cancer A (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRef
13.
Zhang X, Tanigawa N (2009) Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc 23:1259–1264CrossRefPubMed
14.
Kang BH, Xuan Y, Hur H, Ahn CW, Cho YK, Han S-U (2012) Comparison of surgical outcomes between robotic and laparoscopic gastrectomy for gastric cancer: the learning curve of robotic surgery. J Gastric Cancer 12:156–163CrossRefPubMedPubMedCentral
15.
jp JGCAjkk-ma, (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRef
16.
17.
Wang FH, Zhang XT, Li YF, Tang L, Qu XJ, Ying JE, Zhang J, Sun LY, Lin RB, Qiu H, Wang C, Qiu MZ, Cai MY, Wu Q, Liu H, Guan WL, Zhou AP, Zhang YJ, Liu TS, Bi F, Yuan XL, Rao SX, Xin Y, Sheng WQ, Xu HM, Li GX, Ji JF, Zhou ZW, Liang H, Zhang YQ, Jin J, Shen L, Li J, Xu RH (2021) The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2021. Cancer Commun (Lond). https://​doi.​org/​10.​1002/​cac2.​12193CrossRefPubMedPubMedCentral
18.
19.
Choi S, Song JH, Lee S, Cho M, Kim YM, Kim HI, Hyung WJ (2022) Trends in clinical outcomes and long-term survival after robotic gastrectomy for gastric cancer: a single high-volume center experience of consecutive 2000 patients. Gastric Cancer 25:275–286CrossRefPubMed
20.
Nakagawa M, Kojima K, Inokuchi M, Kato K, Sugita H, Kawano T, Sugihara K (2014) Patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy: reliable results following long-term follow-up. Eur J Surg Oncol (EJSO) 40:1376–1382CrossRefPubMed
21.
Michels NA (1966) Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 112:337–347CrossRefPubMed
22.
23.
24.
López-Andújar R, Moya A, Montalvá E, Berenguer M, De Juan M, San Juan F, Pareja E, Vila JJ, Orbis F, Prieto M (2007) Lessons learned from anatomic variants of the hepatic artery in 1081 transplanted livers. Liver Transpl 13:1401–1404CrossRefPubMed
25.
Song S-Y, Chung JW, Yin YH, Jae HJ, Kim H-C, Jeon UB, Cho BH, So YH, Park JH (2010) Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology 255:278–288CrossRefPubMed
26.
Kozhevnikova T (1977) Age and individual characteristics in the structure of the celiac trunk in man. Arkhiv Anatomii, Gistologii i Embriologii 72:19–25PubMed
27.
Silveira LAd, Silveira FBC, Fazan VPS (2009) Arterial diameter of the celiac trunk and its branches: anatomical study. Acta cirurgica brasileira 24:43–47CrossRefPubMed
28.
Oki E, Sakaguchi Y, Hiroshige S, Kusumoto T, Kakeji Y, Maehara Y (2011) Preservation of an aberrant hepatic artery arising from the left gastric artery during laparoscopic gastrectomy for gastric cancer. J Am Coll Surg 212:e25–e27CrossRefPubMed
29.
Gao Y, Hu J, Zhang X, Zhang M, Wang D, Zheng X, Liu S, Lu Y (2019) Use of hisense computer-assisted surgery system enhances infrapyloric lymph node dissection for gastric cancer. J Surg Res 242:31–39CrossRefPubMed
30.
Natsume T, Shuto K, Yanagawa N, Akai T, Kawahira H, Hayashi H, Matsubara H (2011) The classification of anatomic variations in the perigastric vessels by dual-phase CT to reduce intraoperative bleeding during laparoscopic gastrectomy. Surg Endosc 25:1420–1424CrossRefPubMed
31.
Willard C-D, Kjaestad E, Stimec BV, Edwin B, Ignjatovic D, Oresland T, Bakka AO, Reiertsen O, Færden AE, Thorsen Y, Andersen SN, Negaard A, Dicko A, Pfeffer F, Forsmo H, Ytre-Hauge S, Nesgaard JM, Jacobsen R, von Brandis KML, Suhrke P, Luzon J, Sevinç B, Andersen BT, Gaupset R, Bergamaschi R, Pullig F, Baral J, Ruiz MG, Lindstrøm J, Sheikh AE, Strommen T, Group RCCS (2019) Preoperative anatomical road mapping reduces variability of operating time, estimated blood loss, and lymph node yield in right colectomy with extended D3 mesenterectomy for cancer. Int J Colorectal Dis 34:151–160CrossRefPubMed
32.
Winston CB, Lee NA, Jarnagin WR, Teitcher J, DeMatteo RP, Fong Y, Blumgart LH (2007) CT angiography for delineation of celiac and superior mesenteric artery variants in patients undergoing hepatobiliary and pancreatic surgery. AJR Am J Roentgenol 189:W13-19CrossRefPubMed
33.
Lee S-W, Shinohara H, Matsuki M, Okuda J, Nomura E, Mabuchi H, Nishiguchi K, Takaori K, Narabayashi I, Tanigawa N (2003) Preoperative simulation of vascular anatomy by three-dimensional computed tomography imaging in laparoscopic gastric cancer surgery. J Am Coll Surg 197:927–936CrossRefPubMed
34.
Kulig J, Sierzega M, Kolodziejczyk P, Dadan J, Drews M, Fraczek M, Jeziorski A, Krawczyk M, Starzynska T, Wallner G (2010) Implications of overweight in gastric cancer: a multicenter study in a Western patient population. Eur J Surg Oncol (EJSO) 36:969–976CrossRefPubMed
35.
Lee JH, Paik YH, Lee JS, Ryu KW, Kim CG, Park SR, Kim YW, Kook MC, Nam B-h, Bae J-M (2007) Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol 14:1288–1294CrossRefPubMed
36.
Wu XS, Wu WG, Li ML, Yang JH, Ding QC, Zhang L, Mu JS, Gu J, Dong P, Lu JH, Liu YB (2013) Impact of being overweight on the surgical outcomes of patients with gastric cancer: a meta-analysis. World J Gastroenterol 19:4596–4606CrossRefPubMedPubMedCentral
37.
Romero FR, Rais-Bahrami S, Muntener M, Brito FAR, Jarrett TW, Kavoussi LR (2008) Laparoscopic partial nephrectomy in obese and non-obese patients: comparison with open surgery. Urology 71:806–809CrossRefPubMed
38.
Williams TK, Rosato EL, Kennedy EP, Chojnacki KA, Andrel J, Hyslop T, Doria C, Sauter PK, Bloom J, Yeo CJ, Berger AC (2009) Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg 208:210–217CrossRefPubMed
39.
Kodera Y, Ito S, Yamamura Y, Mochizuki Y, Fujiwara M, Hibi K, Ito K, Akiyama S, Nakao A (2004) Obesity and outcome of distal gastrectomy with D2 lymphadenectomy for carcinoma. Hepatogastroenterology 51:1225–1228PubMed
40.
Jiang J, Teng Y, Fan Z, Khan S, Xia Y (2014) Does obesity affect the surgical outcome and complication rates of spinal surgery? A meta-analysis. Clin Orthop Relat Res 472:968–975CrossRefPubMed
41.
Meng C, Cao S, Liu X, Li L, He Q, Xia L, Jiang L, Chu X, Wang X, Wang H, Hui X, Sun Z, Huang S, Duan Q, Yang D, Zhang H, Tian Y, Li Z, Zhou Y (2021) Effect of preoperative CT angiography examination on the clinical outcome of patients with BMI >/= 25.0 kg/m2 undergoing laparoscopic gastrectomy: study protocol for a multicentre randomized controlled trial. Trials 22:912CrossRefPubMedPubMedCentral
Metadata
Title
Short- and long-term outcomes of laparoscopic or robotic radical gastrectomy based on preoperative perigastric artery CTA surgical decision-making: a high-volume center retrospective study with propensity score matching
Authors
Cheng Meng
Shougen Cao
Yulong Tian
Shuai Shen
Xiaodong Liu
Zequn Li
Yu Li
Yuqi Sun
Jianfei Xu
Xingqi Zhang
Ying Kong
Xujie Wang
Hao Yang
Hao Zhong
Zhuoyu Jia
Dongfeng Zhang
Yanbing Zhou
Publication date
16-06-2023
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2023
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-023-10170-2

Other articles of this Issue 9/2023

Surgical Endoscopy 9/2023 Go to the issue

2023 SAGES Poster

External validation of the Japanese difficulty score for laparoscopic hepatectomy in patients undergoing robotic-assisted hepatectomy

OriginalPaper

Process model analysis of parenchyma sparing laparoscopic liver surgery to recognize surgical steps and predict impact of new technologies

Dynamic Manuscript

End-to-end invaginated pancreaticojejunostomy during minimally invasive pancreatoduodenectomy: technical description and single center experience

Review Article

Safety and efficacy of LA-ERCP procedure following Roux-en-Y gastric bypass: a systematic review and meta-analysis

2023 SAGES Oral

Randomized single blind trial to compare the short term post-operative outcome and cost analysis of laparoscopic versus ultrasound guided transversus abdominis plane block in patients undergoing bariatric surgery

2023 SAGES Oral

Assessing the effects of smoking status on outcomes of elective minimally invasive paraesophageal hernia repair