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Akashi Yoshimasa,Ogawa Koichi,Hisakura Katsuji,Enomoto Tsuyoshi,Ohara Yusuke,Owada Yohei,Hashimoto Shinji,Takahashi Kazuhiro,Shimomura Osamu,Doi Manami,Miyazaki Yoshihiro,Furuya Kinji,Moue Shoko,Oda T 대한위암학회 2022 Journal of gastric cancer Vol.22 No.3
Purpose Total or proximal gastrectomy of the upper-third early gastric cancer (u-EGC) often causes severe post-gastrectomy syndrome, suggesting that these procedures are extremely invasive for patients without pathologically positive lymph node (LN) metastasis. This study aimed to evaluate the clinical applicability of a stomach function-preserving surgery, local resection (LR), with prophylactic left gastric artery (LGA)-basin dissection (LGA-BD). Materials and Methods The data of patients with u-EGC (pathologically diagnosed as T1) were retrospectively analyzed. Total gastrectomy was performed in 30 patients, proximal gastrectomy in 45, and subtotal gastrectomy in 6; the LN status was evaluated assuming that the patients had already underwent LR + LGA-BD. This procedure was considered feasible in patients without LN metastases or in patients with cancer in the LGA basin. The reproducibility of the results was also evaluated using an external validation dataset. Results Of the 82 eligible patients, 79 (96.3%) were cured after undergoing LR + LGA-BD, 74 (90.2%) were pathologically negative for LN metastases, and 5 (6.1%) had LN metastases, but these findings were only observed in the LGA basin. Similarly, of the 406 eligible tumors in the validation dataset, 396 (97.5%) were potentially curative. Tumors in the lesser curvature, post-endoscopic resection status, and small tumors (<20 mm) were considered to be stronger indicators of LR + LGA-BD as all subpopulation cases met our feasibility criteria. Conclusions More than 95% of the patients with u-EGC might be eligible for LR + LGA-BD. This function-preserving procedure may contribute to the development of u-EGC without pathological LN metastases, especially for tumors located at the lesser curvature Purpose Total or proximal gastrectomy of the upper-third early gastric cancer (u-EGC) often causes severe post-gastrectomy syndrome, suggesting that these procedures are extremely invasive for patients without pathologically positive lymph node (LN) metastasis. This study aimed to evaluate the clinical applicability of a stomach function-preserving surgery, local resection (LR), with prophylactic left gastric artery (LGA)-basin dissection (LGA-BD). Materials and Methods The data of patients with u-EGC (pathologically diagnosed as T1) were retrospectively analyzed. Total gastrectomy was performed in 30 patients, proximal gastrectomy in 45, and subtotal gastrectomy in 6; the LN status was evaluated assuming that the patients had already underwent LR + LGA-BD. This procedure was considered feasible in patients without LN metastases or in patients with cancer in the LGA basin. The reproducibility of the results was also evaluated using an external validation dataset. Results Of the 82 eligible patients, 79 (96.3%) were cured after undergoing LR + LGA-BD, 74 (90.2%) were pathologically negative for LN metastases, and 5 (6.1%) had LN metastases, but these findings were only observed in the LGA basin. Similarly, of the 406 eligible tumors in the validation dataset, 396 (97.5%) were potentially curative. Tumors in the lesser curvature, post-endoscopic resection status, and small tumors (<20 mm) were considered to be stronger indicators of LR + LGA-BD as all subpopulation cases met our feasibility criteria. Conclusions More than 95% of the patients with u-EGC might be eligible for LR + LGA-BD. This function-preserving procedure may contribute to the development of u-EGC without pathological LN metastases, especially for tumors located at the lesser curvature
Mukae Yosuke,Furukawa Kojiro,Noguchi Ryo,Oda Yoshimasa,Furutachi Akira,Takamatsu Masanori,Itoh Manabu,Kamohara Keiji,Morita Shigeki,Nishida Takahiro 경희대학교 융합한의과학연구소 2021 Oriental Pharmacy and Experimental Medicine Vol.21 No.2
Daikenchuto (TJ-100) is a Japanese traditional herbal medicine that enhances postoperative enterokinesis and increases the intestinal blood flow. Daikenchuto has historically played a positive role in the perioperative management of gastrointestinal surgery. However, the effect of Daikenchuto on improving nutrition after cardiac operation has never been reported. This study evaluated the effect of Daikenchuto administration after cardiac operation. Eighty-four patients who underwent isolated first aortic valve replacement (AVR) at our department from May 2008 to December 2014 were enrolled in this study and retrospectively examined. We administered Daikenchuto when patients started their water intake. Blood tests were performed before and seven days after AVR. We prescribed Daikenchuto for 21 patients (group D). The reductions in the albumin level and prognostic nutritional index (p = 0.045, p = 0.008, respectively, multivariate analysis of variance) after the operation were significantly lower in group D (3.75 ± 0.3 to 3.33 ± 0.4 and 44.7 ± 4.8 to 41.3 ± 6.7 mg/dl, respectively) than in the group without Daikenchuto (group N, 63 patients) (3.74 ± 0.5 to 3.13 ± 0.4 and 44.6 ± 6.3 to 37.7 ± 5.3 mg/dl, respectively). There were no significant differences in the incidence rates of postoperative complications or hospitalization duration between the two groups. Postoperative Daikenchuto administration is considered to be safe and effective for improving the postoperative nutritional status after simple AVR as well as digestive surgery.