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Supplemental Digital Content is available in the text, In gastrointestinal stromal tumors (GISTs), rupture is a high-risk feature; however, “tumor rupture” is inconsistently defined, and its prognostic value remains controversial. Six hundred ninety-one patients undergoing surgery for primary nonmetastatic GISTs from 2003 to 2015 at our institution were enrolled. The strict definitions of “tumor rupture” according to the Kinki GIST Study Group (KGSG) were used. The median follow-up time was 64 months. The 5-year recurrence-free survival (RFS) and overall survival (OS) rates in the entire group were 79.3% and 84.1%, respectively. According to the KGSG's definition, tumor rupture occurred only in 24 (3.5%) of 691 patients. For all 691 patients, multivariable analysis showed that tumor rupture, according to KGSG's definition, is one of the independently prognostic factors for both RFS and OS. Twenty-four patients with tumor rupture were further analyzed. Receiving IM for more than 3 years was significantly associated with improved RFS and OS in GISTs patients with tumor rupture. Tumor rupture according to KGSG's definition was an independent predictive factor associated with GIST patient prognosis. More importantly, for GISTs with tumor rupture according to the KGSG's strict definition, receiving IM treatment for ≥3 years should be considered.

Published reports on laparoscopic resection of gastric gastrointestinal stromal tumor (GIST) were limited to small experiences and selection bias. Two hundred fourteen patients who underwent primary gastric GIST resection at our institution (January 2006–December 2012) were identified from a prospectively collected database. Laparoscopic resections (LAP) were performed in 133 patients, and open resections (OPEN) were performed in 81 patients. The short- and long-term outcomes were analyzed using propensity-score matching (PSM) by comparing the clinicopathological factors between these groups. The tumor resection method and tumor size were significantly different between the LAP and OPEN groups. After PSM, there were no differences (P > 0.05) in these clinicopathological factors. The LAP group had less blood loss and shorter operation time, time to first flatus, time to first fluid diet, time to gastric tube removal, and postoperative stay before PSM. In addition, there were no differences regarding the time of drainage tube removal or hospitalization expense. Other than the time of gastric tube removal, which was similar in these 2 groups, the short-term outcomes were similar before and after PSM. The rates of postoperative complications in the LAP and OPEN groups were 6.8% and 22.8%, respectively, before PSM (P = 0.001) and 5.6% and 22.5%, respectively, after PSM (P = 0.004). The multivariate analyses for complications showed that tumors were located in the middle of the stomach, and the operation method and proximal gastrectomy were independent risk factors before and after PSM. The 5-year cumulative survival rates in the LAP and OPEN groups were 95.4% and 85.9%, respectively, (P = 0.07) before PSM and 93.1% and 91.9%, respectively, (P = 0.69) after PSM (not significantly different). Laparoscopic resection for gastric GISTs had better short-term outcomes and similar long-term outcomes compared with open surgery. Localized gastric GISTs can be treated with laparoscopic surgery.

To investigate the learning curve of the application of Huang 3-step maneuver, which was summarized and proposed by our center for the treatment of advanced upper gastric cancer. From April 2012 to March 2013, 130 consecutive patients who underwent a laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) by a single surgeon who performed Huang 3-step maneuver were retrospectively analyzed. The learning curve was analyzed based on the moving average (MA) method and the cumulative sum method (CUSUM). Surgical outcomes, short-term outcomes, and follow-up results before and after learning curve were contrastively analyzed. A stepwise multivariate logistic regression was used for a multivariable analysis to determine the factors that affect the operative time using Huang 3-step maneuver. Based on the CUSUM, the learning curve for Huang 3-step maneuver was divided into phase 1 (cases 1–40) and phase 2 (cases 41–130). The dissection time (DT) (P

This study investigated anatomical variations in the confluence types of the right gastroepiploic vein (RGEV) to improve knowledge regarding no. 6 lymphadenectomy for laparoscopic gastrectomy. The RGEV drainage patterns of 144 patients who were diagnosed with gastric cancer and underwent laparoscopic distal gastrectomy at our department from July 2010 to June 2011 were prospectively collected and retrospectively analyzed, and we compared the impact of different drainage patterns on no. 6 lymphadenectomy. The RGEV confluence types were classified into 6 categories in this study. Types I, II, and III, which were observed in 53 (36.8%), 27 (18.8%), and 21 (14.6%) cases, respectively, were the most frequently found during gastrectomy. All 3 of these types included a gastropancreatic trunk and were defined as the gastropancreatic group (GP group). In addition, 15 cases (10.4%) were categorized as type IV, 19 (13.2%) were categorized as type V, and 9 (6.3%) were categorized as type VI. These 3 types, which could form a gastrocolic trunk, were defined as the gastrocolic group (GC group). No significant differences were found with respect to the clinicopathological characteristics, postoperative morbidity, perioperative mortality, and 3-year overall survival rates after surgery between the 2 groups (all P > 0.05). However, the mean no. 6 lymph node (No. 6 LN) dissection time, the mean blood loss due to No. 6 LN dissection and the rate of infrapyloric vascular injury were significantly increased in the GC group compared with the GP group (all P

To investigate the risk factors for postoperative complications following laparoscopic gastrectomy (LG) for gastric cancer and to use the risk factors to develop a predictive scoring system. Few studies have been designed to develop scoring systems to predict complications after LG for gastric cancer. We analyzed records of 2170 patients who underwent a LG for gastric cancer. A logistic regression model was used to identify the determinant variables and develop a predictive score. There were 2170 patients, of whom 299 (13.8%) developed overall complications and 78 (3.6%) developed major complications. A multivariate analysis showed the following adverse risk factors for overall complications: age ≥65 years, body mass index (BMI) ≥ 28 kg/m2, tumor with pyloric obstruction, tumor with bleeding, and intraoperative blood loss ≥75 mL; age ≥65 years, a Charlson comorbidity score ≥3, tumor with bleeding and intraoperative blood loss ≥75 mL were identified as independent risk factors for major complications. Based on these factors, the authors developed the following predictive score: low risk (no risk factors), intermediate risk (1 risk factor), and high risk (≥2 risk factors). The overall complication rates were 8.3%, 15.6%, and 29.9% for the low-, intermediate-, and high-risk categories, respectively (P

This article investigated the feasibility of laparoscopic surgery in unfavorable site gastric gastrointestinal stromal tumors (GISTs). We identified 214 patients who underwent primary gastric GIST resection at our institution (January 2006–December 2014) from a prospectively collected database. These patients were divided into a Favorable group (140 cases) and an Unfavorable group (74 cases) according to the 2014 version of the National Comprehensive Cancer Network Clinical Guidelines (NCCN guidelines). The wedge resection rate of the Favorable group was higher than that of the Unfavorable group, and most procedures were performed laparoscopically (P 0.05). The postoperative stay of the Unfavorable group was longer than that of the Favorable group (P = 0.02). Laparoscopic surgery in both groups resulted in a shorter operative time, lower blood loss, faster time to first flatus, faster time to first fluid diet, and shorter postoperative stay than open surgery (P 0.05). Furthermore, in the Unfavorable group, the 5-year OS and RFS were similar for both laparoscopic and open procedures. Multivariate Cox regression analysis showed that imatinib (IM) treatment was an independent risk factor for poor prognosis. Laparoscopic operation for gastric GISTs located in unfavorable sites can yield similar long-term outcomes compared with an open operation. However, laparoscopic surgery has the obvious advantage of being minimally invasive, and the incidence of postoperative complications was low. Laparoscopic surgery is thus an option for the treatment of localized gastric GISTs.

The aim of the study is to identify the value of a spleen-preserving No. 10 lymphadenectomy (SPL) for Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG). From January 2007 to June 2014, 694 patients undergoing radical total gastrectomy for Siewert type II/III AEG were analyzed. Oncologic outcomes were compared between SPL and no SPL (No. 10D+ and No. 10D–) groups. The incidence of No. 10 lymph node metastasis (LNM) was 12.3%. No significant differences in the incidence of No. 10 LNM were found between Siewert type II AEG with tumor diameters of

The common hepatic artery (CHA) is an important blood vessel that must be vascularized during D2 lymphadenectomies for gastric cancer. When the CHA is absent, the risk of vascular injury increases.To explore the anatomic classification of CHA absence and its application value in laparoscopic radical resections for gastric cancer.Clinical data were collected prospectively from 2170 gastric cancer patients from June 2007 to December 2013, and the data were analyzed retrospectively. The anatomy of CHA absence was assessed synthetically by combining preoperative CT scans and intraoperative images, which were classified according to the anatomy of replaced hepatic arteries (RHAs) and were grouped into the early-year group (2007-2011) and the later-year group (2012-2013) based on the year in which the operation was performed.CHA absence was noted in 38 cases (1.8%) and was classified into 6 types: type I (replaced CHA [RCHA] from the superior mesenteric artery [SMA] with retropancreatic course, 28), type II (RCHA from the SMA with circumambulated course, 1), type III (RCHA from the aortic artery, 1), type IV (replaced left hepatic artery [RLHA] from the left gastric artery [LGA] and replaced right hepatic artery [RRHA] from the SMA, 5), type V (RLHA from the LGA and RRHA from the celiac artery, 2), and type VI (RLHA from the aberrant gastroduodenal artery and RRHA from the SMA, 1). Of the 38 cases, 17 cases (44.7%) belong to the early-year group, and 21 cases (55.3%) belong to the later-year group. The vascular injury rate was significantly lower in the later-year group than in the early-year group (4.8% [1/21] vs 41.2% [7/17], P = 0.005]. Additionally, the alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) values were significantly lower in the later-year group than in the early-year group on postoperative day 3 (all P < 0.05).A 6-type anatomic classification system can be used to demonstrate variations in features resulting from CHA absence in detail. Knowledge regarding a patient's classification is helpful for surgeons, and vascular injury and liver function damage may be reduced in patients who are properly classified prior to surgery.