ObjectiveTo study the clinical significance of prognostic nutritional index (PNI) combined with neutrophil to lymphocyte ratio (NLR) in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.MethodsTo retrospectively analyze and collect the clinical data of 517 patients with gastric cancer who were diagnosed at the Third People’s Hospital of Shangqiu City from January 2016 to May 2020, all of the patients received radical gastrectomy. We explored the risk factors that affect the occurrence of postoperative anastomotic leakage, and explored the clinical significance of PNI combined with NLR on the third day after operation in predicting the occurrence of anastomotic leakage.ResultsAmong 517 patients undergoing radical gastrectomy, 61 had anastomotic leakage, and the incidence of anastomotic leakage was 11.8%. The results of multivariate logistic regression analysis showed that patients with preoperative diabetes and intraoperative blood loss ≥400 mL had a higher incidence of anastomotic leakage, and with the increase of NLR value on the 3rd and 5th day after operation, and the decrease of PNI value on the 3rd and 5th day after operation, the incidence of anastomotic leakage increased (P<0.05). The area under the curve of NLR, PNI, and NLR combined with PNI on the 3rd day after operation in predicting the occurrence of anastomotic leakage were 0.849, 0.581, and 0.949, respectively, and the differences were statistically significant (P<0.05), the sensitivity and specificity of NLR combined with PNI were higher than the individual indicator.ConclusionPNI combined with NLR on the 3rd day after operation has important clinical significance in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.
ObjectiveTo assess the outcomes of laparoscopy-assisted surgery for treatment of advanced gastric cancer.MethodsA total of 115 patients with advanced gastric cancer were included between January 2014 and December 2018 were analyzed retroprospectively, the patients were divided into two groups: open surgery group (OS group, n=63) and laparoscopy-assisted surgery group (LAS group, n=52). Baseline characteristics, intraoperative parameters and postoperative items, and long-term efficacy were compared between the two groups.ResultsThere was no significant difference in preoperative baseline data including gender, age and preoperative serum parameters between the two groups (P>0.05). Intraoperative blood loss in the LAS group was significantly less than that in the OS group (P<0.05). In addition, the first feeding time after operation and postoperative hospital stay in the LAS group were significantly shorter than the OS group (P<0.05). Furthermore, numbers of white blood cells and neutrophils in the LAS group were fewer than that in the OS group at postoperative 2 days (P<0.05); the level of serum albumin in the LAS group was higher than that OS group (P<0.05). The number of lymph nodes detected during operation in the LAS group was more than that in the OS group (P<0.05). Operative time and occurrence of postoperative complications were not statistically significant between the two groups (P>0.05). One hundred and ten of 115 patients were followed- up, the follow-up rate was 95.7%. The follow-up time ranged from 6 to 48 months, with a median follow-up time of 12.4 months. The disease-free survival time of the OS group was 12.2±6.5 months, while that of the LAS group was 13.5±7.4 months. There was no significant difference between the two groups (P>0.05).ConclusionsLaparoscopic technique in treatment of advanced gastric cancer has the minimally invasive advantage, less intraoperative blood loss, less surgical trauma, and faster postoperative recovery in comparing to the traditional open surgery. Also the lymph node dissection is superior to open surgery. The curative effect is comparable to that of open surgery.
ObjectiveTo explore risk factors for sarcopenia after radical gastrectomy for gastric cancer in older patients. MethodsOlder patients who underwent radical gastrectomy for gastric cancer at Tangshan People’s Hospital from January 2022 to June 2023 were retrospectively collected. The occurrence of sarcopenia was recorded, and factors influencing its development were analyzed. Factors with statistical significance in univariate analysis and clinical relevance were included in a multivariate binary logistic regression model. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of significant predictors for sarcopenia occurrence. ResultsA total of 300 older patients underwent radical gastrectomy for gastric cancer were enrolled. Sarcopenia occurred in 74 patients (incidence rate: 24.7%). Multivariate binary logistic regression analysis identified the following independent risk factors for sarcopenia (all P<0.05): American Society of Anesthesiologists (ASA) class Ⅲ, postoperative chemotherapy, geriatric nutritional risk index (GNRI) <89, body mass index (BMI) <18.5 kg/m2, lack of exercise habits, and lower levels of serum total protein, grip strength, skeletal muscle mass index (SMI), 6-meter walking speed, and short physical performance battery (SPPB) score. Among these, factors with an area under the ROC curve (AUC) >0.7 were serum total protein, SMI, and 6-meter walking speed. The combined model integrating these three factors achieved an AUC of 0.937 (sensitivity 96.65%; specificity 89.71%; Youden index 0.844). ConclusionsThis study reveals a high incidence of sarcopenia after radical gastrectomy in older gastric cancer patients. The risk of sarcopenia is multifactorial, involving surgical tolerance (ASA classification), postoperative therapy (chemotherapy), nutritional status (GNRI and BMI), exercise habits, and various muscle-related functional indicators (serum total protein, grip strength, SMI, walking speed, and physical performance score). The combined predictive model shows potential for early identification of high-risk patients and timely preventive interventions.