| 1 | Improving the outcomes in gastric cancer surgery显示文摘Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and fiveyear survival rates are poor,therefore a continuous strive to improve outcomes for these patients is warranted. Fortunately,in the last decades several potential advances have been introduced that intervene at various stages of the treatment process. This review provides an overview of methods implemented in pre-,intra- and postoperative stage of gastric cancer surgery to improve outcome. Better preoperative risk assessment using comorbidity index(e.g.,Charlson comorbidity index),assessment of nutritional status(e.g.,short nutritional assessment questionnaire,nutritional risk screening- 2002) and frailty assessment(Groningen frailty indicator,Edmonton frail scale,Hopkins frailty) was introduced. Also preoperative optimization of patients using prehabilitation has future potential.Implementation of fast-track or enhanced recovery after surgery programs is showing promising results,although future studies have to determine what the exact optimal strategy is.Introduction of laparoscopic surgery has shown improvement of results as well as optimization of lymph node dissection.Hyperthermic intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus far.Advances in postoperative care include optimal timing of oral diet,which has been shown to reduce hospital stay.In general,hospital volume,i.e.,centralization,and clinical audits might further improve the outcome in gastric cancer surgery.In conclusion,progress has been made in improving the surgical treatment of gastric cancer.However,gastric cancer treatment is high risk surgery and many areas for future research remain. | Juul JW Tegels Michiel FG De Maat Karel WE Hulsewé Anton GM Hoofwijk Jan HMB Stoot | 2014 | World Journal of Gastroenterology2014，20，38： | 16 |
| 2 | Introduction of laparoscopic gastrectomy for gastric cancer in a Western tertiary referral centre:A prospective cost analysis during the learning curve显示文摘AIM To evaluate the costs of the introduction of a laparoscopic surgery program for gastric cancer in a Western community training hospital and tertiary referral centre for gastric cancer surgery. METHODS All patients who underwent surgery for gastric cancer with curative intent in 2013 and 2014 were prospectively included. Primary outcomes were costs regarding surgery and hospital stay. RESULTS Laparoscopic gastrectomy was used in 52 patients [mean age 68 years(± 9, range 50 to 87) years] and open gastrectomy was used in 25 patients [mean age 70 years(± 10, range 46 to 85)]. Mean costs(in euro's) of surgical instrumentation were significantly higher for laparo-scopic surgery: 2270 ± 670 vs 1181 ± 680 in the open approach(P < 0.001). Costs of theatre use were higher in the laparoscopic group: mean 3818 ± 865 vs 2545± 1268 in the open surgery(P < 0.001). Total costs of hospitalization(i.e., costs of surgery and admission)were not different between laparoscopic and open surgery, 8187 ± 4864 and 6152 ± 2680 respectively(P= 0.729). Mean length of hospital stay was 9 ± 12 d in the laparoscopic group vs 14 ± 14 d in the open group(P= 0.044). CONCLUSION The introduction of laparoscopic gastrectomy for gastric cancer coincided with higher costs for theatre use and surgical instrumentation compared to the open technique. Total costs were not significantly different due to shorter length of stay and less intensive care unit(ICU) admissions and shorter ICU stay in the laparoscopic group. | Juul J Tegels Charlotte E Silvius Frederique E Spauwen Karel W Hulsewé Anton G Hoofwijk Jan H Stoot | 2017 | World Journal of Gastrointestinal Oncology2017，9，5： | 2 |
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