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// Xin-Sheng Xie 1, 2, 3, 4, * , Jian-Xian Lin 1, 2, 3, 4, * , Ping Li 1, 2, 3, 4 , Jian-Wei Xie 1, 2 , Jia-Bin Wang 1, 2, 3, 4 , Jun Lu 1, 2 , Qi-Yue Chen 1, 2 , Long-Long Cao 1, 2 , Mi Lin 1, 2 , Ru-Hong Tu 1, 2 , Chang-Ming Huang 1, 2, 3, 4 and Chao-Hui Zheng 1, 2 1 Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China 2 Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China 3 Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China 4 Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China * These authors contributed equally to this work and share co-first authorship Correspondence to: Chang-Ming Huang, email: hcmlr2002@163.com Chao-Hui Zheng, email: wwkzch@163.com Keywords: gastric cancer, postoperative hemorrhage, laparoscopy, D2 lymphadenectomy, risk factor Received: July 14, 2017 Accepted: August 27, 2017 Published: September 11, 2017 ABSTRACT Objectives: To investigate risk factors of postoperative hemorrhage (PH) following laparoscopy-assisted radical gastrectomy (LARG) with D2 lymphadenectomy for primary gastric cancer (PGC) and to use those risk factors to develop a scoring system for risk assessment. Materials and Methods: A total of 1789 PGC patients were enrolled in our study. We analyzed the risk factors of PH and constructed a scoring system using 75% of the cases as the experimental group and 25% of the cases as a verification group to demonstrate the effectiveness. Results: Among these 1789 patients, 46 (2.6%) developed PH. Univariate and multivariate analysis in the experimental group indicated that having more than 41 lymph node excisions, combined organ resection, stage III tumor and postoperative digestive fistula were independent risk factors of PH. According to the independent risk factors, we constructed a scoring system to separate patients into low-risk (0–2 points) and high-risk (≥ 3 points) groups. The area under the ROC curve for this scoring system was 0.748. In the verification group, the risk of PH predicted by the scoring system was not significantly different from the actual incidence observed. Conclusions: This scoring system could simply and effectively predict the occurrence of PH following LARG with D2 lymphadenectomy for PGC. The predictive system will help surgeons evaluate risk and select risk-adapted interventions to improve surgical safety.

// Jun Lu 1, 2, 3, 4 , Chao-Hui Zheng 1, 2, 3, 4 , Long-Long Cao 1, 2, 3, 4 , Ping Li 1, 2, 3, 4 , Jian-Wei Xie 1, 2, 3, 4 , Jia-Bin Wang 1, 2, 3, 4 , Jian-Xian Lin 1, 2, 3, 4 , Qi-Yue Chen 1, 2, 3, 4 , Mi Lin 1, 2, 3, 4 , Ru-Hong Tu 1, 2, 3, 4 and Chang-Ming Huang 1, 2, 3, 4 1 Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China 2 Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China 3 Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China 4 Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China Correspondence to: Chang-Ming Huang, email: hcmlr2002@163.com Keywords: gastric cancer, TNM classification, prognosis, 8th edition Received: February 02, 2017 Accepted: April 26, 2017 Published: June 06, 2017 ABSTRACT Background and Objectives: The eighth TNM edition for gastric cancer was released in 2016 and included major revisions, especially of stage III. The purpose of this study was to evaluate the prognostic value of the new AJCC TNM classification in comparison with the 7th edition for stage III gastric cancer. Methods: Clinical and histopathological data on 1,496 patients operated on for stage III GC according to the seventh edition between 2005 and 2013 were analyzed and compared using 7th and 8th classifications. The 2 systems were compared in terms of prognostic performance. Results: The stage shifted for 650 (43.45%) patients: from IIIA to IIIB (2 patient, 0.13%), from IIIB to IIIA (214 patients, 14.30%), from IIIB to IIIC (99 patients, 6.62%), and from IIIC to IIIB (335 patients, 22.39%). Cox regression multivariate analysis showed both the 8th and 7th TNM classification were independent prognostic factors. The 8th edition system had higher linear trend and likelihood ratio χ 2 scores, and smaller AIC values compared with those for the 7th edition. However, the performance of the eighth edition did not reveal significant improvement compared to the seventh edition (c-index 0.625 vs. c-index 0.616, p=0.085). Conclusion: The eighth TNM edition may not provide significantly better accuracy in predicting the prognosis of stage III GC. However, to confirm our findings, further studies are warranted.

// Jun-Peng Lin 1 , Jian-Xian Lin 1 , Long-Long Cao 1 , Chao-Hui Zheng 1 , Ping Li 1 , Jian-Wei Xie 1 , Jia-Bin Wang 1 , Jun Lu 1 , Qi-Yue Chen 1 , Mi Lin 1 , Ru-Hong Tu 1 and Chang-Ming Huang 1 1 Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China Correspondence to: Chang-Ming Huang, email: hcmlr2002@163.com Keywords: gastric cancer, preoperative lymphocyte-to-monocyte ratio, nomogram, overall survival, recurrence Received: December 09, 2016 Accepted: March 20, 2017 Published: April 12, 2017 ABSTRACT Objectives: To evaluate the predictive value of the preoperative lymphocyte-to-monocyte ratio (LMR) for the prognosis of patients with gastric cancer (GC) after radical-intent surgery. Methods: We retrospectively analyzed 1,810 patients who underwent radical-intent gastrectomy for primary GC from December 2008 to December 2013. X-tile software was used to identify the optimal value for blood LMR. Nomograms were developed to predict overall survival (OS) and recurrence-free survival (RFS) after surgery. Results: LMR was significantly lower in patients with GC than in matched normal volunteers (P

// Zhi-Liang Hong 1 , Qi-Yue Chen 1 , Chao-Hui Zheng 1 , Ping Li 1 , Jian-Wei Xie 1 , Jia-Bin Wang 1 , Jian-Xian Lin 1 , Jun Lu 1 , Long-Long Cao 1 , Mi Lin 1 , Ru-Hong Tu 1 and Chang-Ming Huang 1 1 Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China Correspondence to: Chang-Ming Huang, email: hcmlr2002@163.com Keywords: stomach cancer, laparoscopy, spleen-preserving SHLND, No.10 LN metastasis, scoring system Received: December 22, 2016 Accepted: March 29, 2017 Published: April 20, 2017 ABSTRACT Purpose: To investigate upper stomach carcinoma risk factors for No. 10 lymph node (LN) metastasis, and establish a preoperative scoring system to predict No.10 LN metastasis. Method: Between January 2011 and December 2014, we prospectively collected and retrospectively analyzed the data of 398 patients with upper-third gastric cancer (GC) who underwent laparoscopic spleen-preserving hilar lymph-node dissection (SHLND). We use the logistics regression analysis risk factors of No. 10 LN metastasis to establish and verify a scoring model. Result: Among the 398 patients examined, 38 patients had No. 10 LN metastasis, yielding a 9.6% transfer rate. The preoperative risk factor analysis for No. 10 LN metastasis in the modeling group showed that tumor size, preoperative T staging, and preoperative N staging are independent risk factors. To establish a scoring system, we divided the modeling group of patients into three levels: low risk, intermediate risk, and high risk. The No. 10 LN metastasis rates of the low risk, intermediate risk and high risk groups were 2.84%, 13.9% and 34.9% respectively, with statistically significant (P 0.05). Conclusion: The scoring system comprising the tumor size, preoperative T stage and N stage is a simple and effective method to predict the risk of No. 10 LN metastasis and to preoperatively select cases suitable for laparoscopic spleen-preserving SHLND.

// Qi-Yue Chen 1 , Chang-Ming Huang 1 , Chao-Hui Zheng 1 , Ping Li 1 , Jian-Wei Xie 1 , Jia-Bin Wang 1 , Jian-Xian Lin 1 , Jun Lu 1 , Long-Long Cao 1 , Mi Lin 1 and Ru-Hong Tu 1 1 Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China Correspondence to: Chang-Ming Huang, email: // Keywords : gastric carcinoma; enlarged LN; lymphadenectomy; surgical outcomes; propensity score matching Received : June 21, 2016 Accepted : September 28, 2016 Published : October 09, 2016 Abstract Background: To investigate the long-term outcome of laparoscopic radical gastrectomy (LAG) for gastric cancer (GC) with preoperative enlarged lymph nodes (LNs). Materials and Methods: We retrospectively collected data on 855 patients who underwent LAG for GC. The patients were divided into large (>10 mm) and small (≤10 mm) LN groups (LG and SG) based on the preoperative size of the LNs. The outcomes were compared using a 1:1 propensity score-matching method. The enlarged LNs were divided into five areas according to their location. Results: Before matching, the LG was associated with more retrieved LNs than the SG, whereas after matching, the numbers of LNs retrieved were similar. These numbers remained similar as the number of areas with enlarged LNs increased. Before matching, patients in the LG demonstrated a significantly lower 3-year overall survival rate than those in the SG ( p < 0.001). Additionally, in the LG, 3-year overall survival rates were similar among patients with different total numbers of areas with enlarged LNs. After matching, the 3-year overall survival rate of the LG was close to that of the SG (81.1% vs . 72.4%, p = 0.066). A stratified analysis according to the only independent prognostic factor (pTNM stage) demonstrated that the 3-year overall survival rates at each stage were similar between the LG and SG. Conclusions: LAG has similar oncologic outcomes for GC with or without preoperative enlarged LNs in the same tumor stage. Furthermore, the total number of areas with enlarged LNs has no impact on the long-term outcome.

// Long-Long Cao 1 , Jun Lu 1 , Jian-Xian Lin 1 , Chao-Hui Zheng 1 , Ping Li 1 , Jian-Wei Xie 1 , Jia-Bin Wang 1 , Qi-Yue Chen 1 , Mi Lin 1 , Ru-Hong Tu 1 , Chang-Ming Huang 1 1 Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, 350001, People’s Republic of China Correspondence to: Chang-Ming Huang, email: hcmlr2002@163.com Keywords: gastric neuroendocrine neoplasms, preoperative blood neutrophil-to-lymphocyte ratio, prognosis, tumor recurrence, surveillance strategy Received: March 10, 2016 Accepted: April 27, 2016 Published: June 03, 2016 ABSTRACT Purpose: Evaluate the predictive value of the preoperative blood neutrophil-to-lymphocyte ratio (NLR) on the clinical outcomes of patients with gastric neuroendocrine neoplasms (g-NENs) after radical surgery. Results: The NLR was significantly higher in patients with g-NENs than in matched normal volunteers ( P 0.05). According to the multivariate analysis, the NLR was an independent prognostic factor of RFS and OS. Nomograms, including the NLR, Ki-67 index and lymph node ratio, had superior discriminative abilities to predict clinical outcomes. The recurrence rate was 37% (55/147). The median time to recurrence was 9 months; 48 (87%) patients experienced recurrence within the first 2 years. Both the NLR and Ki-67 index were correlated with liver metastases (both P < 0.05) and were also negatively correlated with recurrence time (both P < 0.05). Materials And Methods: We enrolled 147 patients who were diagnosed with g-NENs and underwent radical surgery. Receiver operating characteristic curve analysis was used to identify the optimal value for blood NLR. Univariate and multivariate survival analysis were used to identify prognostic factors for g-NENs. A nomogram was adopted to predict RFS and OS after surgery. Conclusions: As an independent prognostic factor for g-NENs, blood NLR can improve the predictability of RFS and OS. We recommend that g-NEN patients with a high blood NLR or high Ki-67 index undergo surveillance during the first month and then every 3 months for 2 years post-surgery.

// Jian-Xian Lin 1, * , Ju-Li Lin 1, * , Chao-Hui Zheng 1 , Ping Li 1 , Jian-Wei Xie 1 , Jia-Bin Wang 1 , Jun Lu 1 , Qi-Yue Chen 1 , Long-Long Cao 1 , Mi Lin 1 , Ru-Hong Tu 1 , Ze-Ning Huang 1 and Chang-Ming Huang 1 1 Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China * These authors contributed equally to this work and should be considered co-first authors Correspondence to: Chang-Ming Huang, email: hcmlr2002@163.com Keywords: stomach neoplasms, laparoscopy-assisted total gastrectomy, propensity score matching, prognosis Received: February 14, 2017 Accepted: March 28, 2017 Published: April 05, 2017 ABSTRACT Background: Few studies have been designed to evaluate the short- and long-term outcomes of laparoscopy-assisted total gastrectomy (LATG), and a retrospective study of a large patient cohort is valuable before conducting randomized controlled clinical trials. Results: Among all patients, age, tumor location, histologic type, pT stage, pN stage and pTNM stage significantly differed between the LATG group and OTG group. After the propensity score matching, the clinicopathological characteristics did not significantly differ between groups. The operation time, estimated blood loss, time to first flatus and the number of retrieved lymph nodes ( P < 0.05) were better in the LATG group than the OTG group. Morbidity and mortality were lower in the LATG group than the OTG group ( P < 0.05) for pre-matched patients. However, significant intergroup differences in morbidity were not identified after propensity matching. Although overall survival did not significantly differ between groups for the pre-matched patients, the 3-year cumulative survival rates were significantly lower in the LATG group (89.9%) than the OTG group (97.7%) for patients with stage I disease ( P = 0.028). After propensity score matching, the analysis of the cumulative survival curve did not show a significant difference for any cancer stage. Materials and Methods: We prospectively collected data from 1096 patients who underwent total gastrectomy for gastric cancer. Propensity score matching was applied to compare the covariates between the LATG group and the open total gastrectomy (OTG) group. Operative outcomes and long-term outcomes were compared between the two groups. Conclusions: Implementation of LATG for gastric cancer is a safe, reliable and minimally invasive procedure with long-term outcomes similar to those of OTG. Further randomized controlled clinical trials can be conducted to provide valuable evidence of the safety and efficacy of LATG in treating gastric cancer.