Objective:To evaluate the long-term outcomes and prognostic factors of locally advanced gastric cancer with serosa-invasion.Methods:This study is a retrospective cohort study. The clinical and pathological data of 495 patients with locally advanced gastric cancer with serosa-invasion who underwent laparoscopic radical gastrectomy in Department of General Surgery, the First Hospital Affiliated to Army Medical University from October 2012 to October 2018 was analyzed retrospectively. There were 356 males and 139 females with an age ( M(IQR)) of 59 (16) years (range: 18 to 75 years). Observation indicators included postoperative results and long-term prognosis. The survival curve was drawn by the Kaplan-Meier method. Univariate and multivariate prognostic analysis was performed using the Cox proportional hazards model. Results:Among the 495 patients, a total of 57 patients (11.5%) were lost to follow-up, with a follow-up time of 89 (40) months (range: 23 to 134 months). The 5-year disease-free survival rate (DFS) and the 5-year overall survival rate (OS) were 56.0% and 58.2%, respectively. The 5-year DFS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 60.5%, 51.6%, 33.3%, respectively. The 5-year OS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 62.2%, 54.1%, 39.3%, respectively. Multivariate analysis showed that age >65 years (DFS: HR=1.402, 95% CI: 1.022 to 1.922, P=0.036; OS: HR=1.461, 95% CI: 1.057 to 2.019, P=0.022), lymph node dissection number less than 25 (DFS: HR=1.348, 95% CI: 1.019 to 1.779, P=0.036; OS: HR=1.376, 95% CI: 1.035 to 1.825, P=0.028), pathological stage Ⅲ (DFS: HR=2.131, 95% CI: 1.444 to 3.144, P<0.01; OS: HR=2.079, 95% CI: 1.406 to 3.074, P<0.01), and no postoperative chemotherapy (DFS: HR=3.127, 95% CI: 2.377 to 4.113, P<0.01; OS: HR=3.768, 95% CI: 2.828 to 5.020, P<0.01) were independent prognostic factors for the decrease in DFS and OS rates. Conclusions:Laparoscopic radical gastrectomy for locally advanced gastric cancer with serosa-invasion could achieve satisfactory long-term oncological outcomes. More lymph node dissection and standardized postoperative adjuvant chemotherapy are expected to further improve the prognosis of patients with locally advanced gastric cancer with serous invasion after laparoscopic radical surgery.

Objective:To evaluate the long-term outcomes and prognostic factors of locally advanced gastric cancer with serosa-invasion.Methods:This study is a retrospective cohort study. The clinical and pathological data of 495 patients with locally advanced gastric cancer with serosa-invasion who underwent laparoscopic radical gastrectomy in Department of General Surgery, the First Hospital Affiliated to Army Medical University from October 2012 to October 2018 was analyzed retrospectively. There were 356 males and 139 females with an age ( M(IQR)) of 59 (16) years (range: 18 to 75 years). Observation indicators included postoperative results and long-term prognosis. The survival curve was drawn by the Kaplan-Meier method. Univariate and multivariate prognostic analysis was performed using the Cox proportional hazards model. Results:Among the 495 patients, a total of 57 patients (11.5%) were lost to follow-up, with a follow-up time of 89 (40) months (range: 23 to 134 months). The 5-year disease-free survival rate (DFS) and the 5-year overall survival rate (OS) were 56.0% and 58.2%, respectively. The 5-year DFS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 60.5%, 51.6%, 33.3%, respectively. The 5-year OS for patients with stage ⅡB, ⅢA, ⅢB, ⅢC were 71.2%, 62.2%, 54.1%, 39.3%, respectively. Multivariate analysis showed that age >65 years (DFS: HR=1.402, 95% CI: 1.022 to 1.922, P=0.036; OS: HR=1.461, 95% CI: 1.057 to 2.019, P=0.022), lymph node dissection number less than 25 (DFS: HR=1.348, 95% CI: 1.019 to 1.779, P=0.036; OS: HR=1.376, 95% CI: 1.035 to 1.825, P=0.028), pathological stage Ⅲ (DFS: HR=2.131, 95% CI: 1.444 to 3.144, P<0.01; OS: HR=2.079, 95% CI: 1.406 to 3.074, P<0.01), and no postoperative chemotherapy (DFS: HR=3.127, 95% CI: 2.377 to 4.113, P<0.01; OS: HR=3.768, 95% CI: 2.828 to 5.020, P<0.01) were independent prognostic factors for the decrease in DFS and OS rates. Conclusions:Laparoscopic radical gastrectomy for locally advanced gastric cancer with serosa-invasion could achieve satisfactory long-term oncological outcomes. More lymph node dissection and standardized postoperative adjuvant chemotherapy are expected to further improve the prognosis of patients with locally advanced gastric cancer with serous invasion after laparoscopic radical surgery.

Objective:To investigate the influencing factors for gastrointestinal leakage and its occurrence time after minimally invasive radical gastrectomy for gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 3 135 patients with gastric cancer who were admitted to The First Affiliated Hospital of Army Medical University from January 2004 to December 2022 were collected. There were 2 174 males and 961 females, aged (57±11)years. Gastrointestinal leakage occurring within 4 days after surgery was defined as early gastrointestinal leakage, and gastrointestinal leakage occuring more than 4 days after surgery was defined as late gastrointestinal leakage. Measurement data with normal distribution were represented as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and chi-square test or Fisher exact pro-bability was used for comparison between groups. Comparison of ordinal data was conducted using the nonparameter rank sum test. Logistic regression model was used for univariate analysis, and Logistic forward stepwise regression model was used for multivariate analysis. Results:(1) Clinico-pathological characteristics of patients with and without postoperative gastrointestinal leakage. Of the 3 135 patients, there were 3 056 patients without gastrointestinal leakage and 79 patients with gastrointestinal leakage after operation, and there were significant differences in age, American Society of Anesthesiologists classification, neoadjuvant chemotherapy, surgical resection range, volume of intraoperative blood loss and surgeon′s experience between them ( P<0.05). (2) Postoperative gastro-intestinal leakage and treatment. Of the 79 patients with postoperative gastrointestinal leakage, there were 36 patients with esophagojejunal anastomotic leakage (2 patients combined with jejunal anastomotic leakage), 29 patients with duodenal stump leakage, 11 patients with gastrojejunal anas-tomotic leakage, 2 patients with esophagogastric anastomotic leakage and 1 patient with gastroduo-denal anastomotic leakage. The same patient could be combined with more than one kind of gastro-intestinal leakage. Thirty-four patients were improved after conservative treatment, 31 patients were improved after puncture drainage or endoscopic interventional therapy, and 14 patients were treated with secondary surgery. Among the patients who underwent secondary surgery, 5 patients died during perioperative period. The time to occurrence of postoperative gastrointestinal leakage of 79 patients was 5(4, 8)days, with the earliest occurrence at 1 day after operation, and the latest occurrence at 16 days after operation. (3) Analysis of influencing factors for the occurrence time of postopera-tive gastrointestinal leakage. Results of multivariate analysis showed that neoadjuvant chemotherapy, total gastrectomy and surgeon′s experience ≤50 patients were independent risk factors for early gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=4.262, 2.179, 5.015, 95% confidence interval as 1.386-13.110, 1.026-4.627, 2.378-10.537, P<0.05). Age>60 years, total gastrectomy, volume of intraoperative bleeding loss>200 mL were independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=3.031, 2.804, 2.223, 95% confidence interval as 1.631-5.631, 1.535-5.122, 1.190-4.151, P<0.05). Conclusions:Most patients with gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer can be cured by non-surgical methods. Neoadjuvant chemo-therapy and surgeon′s experience ≤ 50 patients are independent risk factors for early gastrointes-tinal leakage after minimally invasive radical gastrectomy. Age >60 years and volume of intraopera-tive blood loss >200 mL are independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy. Total gastrectomy is an independent risk factor for both early and late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer.

Objective:To investigate the influencing factors for gastrointestinal leakage and its occurrence time after minimally invasive radical gastrectomy for gastric cancer.Methods:The retrospective case-control study was conducted. The clinicopathological data of 3 135 patients with gastric cancer who were admitted to The First Affiliated Hospital of Army Medical University from January 2004 to December 2022 were collected. There were 2 174 males and 961 females, aged (57±11)years. Gastrointestinal leakage occurring within 4 days after surgery was defined as early gastrointestinal leakage, and gastrointestinal leakage occuring more than 4 days after surgery was defined as late gastrointestinal leakage. Measurement data with normal distribution were represented as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M( Q1, Q3), and Mann-Whitney U test was used for comparison between groups. Count data were represented as absolute numbers, and chi-square test or Fisher exact pro-bability was used for comparison between groups. Comparison of ordinal data was conducted using the nonparameter rank sum test. Logistic regression model was used for univariate analysis, and Logistic forward stepwise regression model was used for multivariate analysis. Results:(1) Clinico-pathological characteristics of patients with and without postoperative gastrointestinal leakage. Of the 3 135 patients, there were 3 056 patients without gastrointestinal leakage and 79 patients with gastrointestinal leakage after operation, and there were significant differences in age, American Society of Anesthesiologists classification, neoadjuvant chemotherapy, surgical resection range, volume of intraoperative blood loss and surgeon′s experience between them ( P<0.05). (2) Postoperative gastro-intestinal leakage and treatment. Of the 79 patients with postoperative gastrointestinal leakage, there were 36 patients with esophagojejunal anastomotic leakage (2 patients combined with jejunal anastomotic leakage), 29 patients with duodenal stump leakage, 11 patients with gastrojejunal anas-tomotic leakage, 2 patients with esophagogastric anastomotic leakage and 1 patient with gastroduo-denal anastomotic leakage. The same patient could be combined with more than one kind of gastro-intestinal leakage. Thirty-four patients were improved after conservative treatment, 31 patients were improved after puncture drainage or endoscopic interventional therapy, and 14 patients were treated with secondary surgery. Among the patients who underwent secondary surgery, 5 patients died during perioperative period. The time to occurrence of postoperative gastrointestinal leakage of 79 patients was 5(4, 8)days, with the earliest occurrence at 1 day after operation, and the latest occurrence at 16 days after operation. (3) Analysis of influencing factors for the occurrence time of postopera-tive gastrointestinal leakage. Results of multivariate analysis showed that neoadjuvant chemotherapy, total gastrectomy and surgeon′s experience ≤50 patients were independent risk factors for early gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=4.262, 2.179, 5.015, 95% confidence interval as 1.386-13.110, 1.026-4.627, 2.378-10.537, P<0.05). Age>60 years, total gastrectomy, volume of intraoperative bleeding loss>200 mL were independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer ( odds ratio=3.031, 2.804, 2.223, 95% confidence interval as 1.631-5.631, 1.535-5.122, 1.190-4.151, P<0.05). Conclusions:Most patients with gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer can be cured by non-surgical methods. Neoadjuvant chemo-therapy and surgeon′s experience ≤ 50 patients are independent risk factors for early gastrointes-tinal leakage after minimally invasive radical gastrectomy. Age >60 years and volume of intraopera-tive blood loss >200 mL are independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy. Total gastrectomy is an independent risk factor for both early and late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer.

Objective:To investigate the short-term outcomes of totally robotic surgical system and robotic surgical system assisted radical gastrectomy for gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 290 patients who under-went robotic surgical system radical gastrectomy for gastric cancer in the First Affiliated Hospital of Army Medical University from January 2018 to November 2021 were collected. There were 208 males and 82 females, aged 58 (range, 24?84)years. Of the 290 patients, 125 patients undergoing totally robotic surgical system radical gastrectomy combined with reconstruction of digestive tract were divided into the totally robot group, and 165 patients undergoing robotic surgical system radical gastrectomy combined with a small midline incision-assisted reconstruction of digestive tract were divided into the robotic-assisted group. Observation indicators: (1) surgical and postoperative situations; (2) postoperative complications. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Comparison of ordinal data was conducted using the non-parameter rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Results:(1) Surgical and postoperative situations. The operation time, volume of intraoperative blood loss, length of incision, duration of postoperative analgesic using, time to postoperative gastric tube removal, time to postoperative initial water intake, time to postoperative first anal flatus, duration of post-operative hospital stay were (246±43)minutes, (104±51)mL, 4(range, 3?6)cm, (2.2±0.5)days, 36(range, 10?112)hours, 62(range, 32?205)hours, 63(range, 18?138)hours, 8(range, 6?50)days in patients of the totally robot group, versus (296±59)minutes, (143±87)mL, 6(range, 3?13)cm, (3.6±0.7)days, 42(range, 12?262)hours, 90(range, 18?262)hours, 80(range, 16?295)hours, 9(range, 6?63)days in patients of the robotic-assisted group, showing significant differences in the above indicators between the two groups ( t=8.04, 4.42, Z=?13.98, t=18.46, Z=?5.47, ?5.87, ?6.14, ?4.04, P<0.05). (2) Post-operative complications. Cases with systemic related complications and cases with pulmonary infection were 7 and 4 in patients of the totally robot group, versus 31 and 16 in patients of the robotic-assisted group, showing significant differences in the above indicators between the two groups ( χ2=10.86, 4.68, P<0.05). Further analysis showed that there were significant differences in age ≥60 years, body mass index ≥25 kg/m 2, tumor diameter ≥3 cm, TNM staging as stage Ⅲ of cases with postoperative complications between the totally robot group and the robotic-assisted group ( odds ratio=0.44, 0.17, 0.40, 0.31, 95 confidence interval as 0.20?1.00, 0.03?0.88, 0.18?0.89, 0.11?0.84, P<0.05). Conclusion:Totally robotic surgical system radical gastrectomy for gastric cancer is safe and feasible with advantages of minimal trauma and quick recovery, especially for patients as age ≥60 years, body mass index ≥25 kg/cm 2, tumor diameter ≥3 cm and TNM stage Ⅲ in complication controlling.

Minimally invasive surgery experienced a rapid development in the past thirty years, of which the laparoscopy has been widely used in gastrointestinal surgery. Lymph node dissection is one of the difficulties of laparoscopic radical resection of gastric cancer. The lymph node dissection along the left gastroepiploic vessels is a difficult part, which usually causes bleeding and splenic injury. This article mainly introduce the indications, contraindications, surgical preparations, the difficulties and techniques during the lymph nodes dissection when the operator stood on the left side of the patients, and perioperative complications of lymph nodes dissection along the left gastroepiploic vessels.