Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Clinical Impact of Polyglycolic Acid Mesh to Reduce Pancreas-Related Complications After Minimally Invasive Surgery for Gastric Cancer: A Propensity Score Matching Analysis

  • Motonari Ri (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Manabu Ohashi (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Rie Makuuchi (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Masaru Hayami (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Takeshi Sano (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research) ;
  • Souya Nunobe (Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research)
  • Received : 2024.01.31
  • Accepted : 2024.03.12
  • Published : 2024.04.01
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Abstract

Purpose: Prevention of pancreas-related complications after gastric cancer surgery is critical. Polyglycolic acid (PGA) mesh reduces postoperative pancreatic fistula formation following pancreatic resection. However, the clinical efficacy of PGA mesh in gastric cancer surgery has not been adequately investigated. Materials and Methods: This retrospective study compared the short-term outcomes between two groups: patients who underwent minimally invasive R0 gastrectomy for gastric cancer with the use of a PGA mesh (PGA group) and those without the use of a PGA mesh (non-PGA group) at the Cancer Institute Hospital, Tokyo, between January 2019 and May 2023. Propensity score matching (PSM) was performed to adjust for the possible confounding factors. Results: A total of 834 patients were initially included, of whom 614 (307 in each group) remained after PSM. The amylase levels in the drained abdominal fluid on postoperative days 1 and 3 were similar between the PGA and non-PGA groups. The PGA group had a significantly lower incidence of pancreas-related complications of Clavien-Dindo grade ≥2 than that in the non-PGA group (6.8% vs. 2.9%, P=0.025). In subgroup analyses, the odds ratio for pancreas-related complications appeared to be better in the PGA group than in the non-PGA group in patients with American Society of Anesthesiologists Physical Status Classification score of 2 or 3, those operated via a laparoscopic approach, and those undergoing procedures other than proximal gastrectomy. Conclusions: The use of PGA mesh significantly reduced pancreas-related complications after minimally invasive surgery for gastric cancer and might thus benefit patients at risk of such complications.

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References

  1. Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, et al. Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: the KLASS-01 randomized clinical trial. JAMA Oncol 2019;5:506-513. https://doi.org/10.1001/jamaoncol.2018.6727
  2. Lee HJ, Hyung WJ, Yang HK, Han SU, Park YK, An JY, et al. Short-term outcomes of a multicenter randomized controlled trial comparing laparoscopic distal gastrectomy with D2 lymphadenectomy to open distal gastrectomy for locally advanced gastric cancer (KLASS-02-RCT). Ann Surg 2019;270:983-991. https://doi.org/10.1097/SLA.0000000000003217
  3. Katai H, Mizusawa J, Katayama H, Morita S, Yamada T, Bando E, et al. Survival outcomes after laparoscopy-assisted distal gastrectomy versus open distal gastrectomy with nodal dissection for clinical stage IA or IB gastric cancer (JCOG0912): a multicentre, non-inferiority, phase 3 randomised controlled trial. Lancet Gastroenterol Hepatol 2020;5:142-151. https://doi.org/10.1016/S2468-1253(19)30332-2
  4. Etoh T, Ohyama T, Sakuramoto S, Tsuji T, Lee SW, Yoshida K, et al. Five-year survival outcomes of laparoscopy-assisted vs open distal gastrectomy for advanced gastric cancer: the JLSSG0901 randomized clinical trial. JAMA Surg 2023;158:445-454. https://doi.org/10.1001/jamasurg.2023.0096
  5. Uyama I, Suda K, Nakauchi M, Kinoshita T, Noshiro H, Takiguchi S, et al. Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer 2019;22:377-385. https://doi.org/10.1007/s10120-018-00906-8
  6. Hiki N, Honda M, Etoh T, Yoshida K, Kodera Y, Kakeji Y, et al. Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer 2018;21:162-170. https://doi.org/10.1007/s10120-017-0764-z
  7. Ida S, Hiki N, Ishizawa T, Kuriki Y, Kamiya M, Urano Y, et al. Pancreatic compression during lymph node dissection in laparoscopic gastrectomy: possible cause of pancreatic leakage. J Gastric Cancer 2018;18:134-141. https://doi.org/10.5230/jgc.2018.18.e15
  8. Jiang X, Hiki N, Nunobe S, Kumagai K, Nohara K, Sano T, et al. Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer. Ann Surg Oncol 2012;19:115-121. https://doi.org/10.1245/s10434-011-1893-y
  9. Martiniuc A, Dumitrascu T, Ionescu M, Tudor S, Lacatus M, Herlea V, et al. Pancreatic fistula after D1+/D2 radical gastrectomy according to the updated international study group of pancreatic surgery criteria: risk factors and clinical consequences. experience of surgeons with high caseloads in a single surgical center in Eastern Europe. J Gastric Cancer 2021;21:16-29. https://doi.org/10.5230/jgc.2021.21.e3
  10. Lu H, Zhao B, Zhang J, Huang R, Wang Z, Xu H, et al. Does delayed initiation of adjuvant chemotherapy following the curative resection affect the survival outcome of gastric cancer patients: a systematic review and meta-analysis. Eur J Surg Oncol 2020;46:1103-1110. https://doi.org/10.1016/j.ejso.2020.01.013
  11. Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol 2013;20:1575-1583. https://doi.org/10.1245/s10434-012-2720-9
  12. Tokunaga M, Kurokawa Y, Machida R, Sato Y, Takiguchi S, Doki Y, et al. Impact of postoperative complications on survival outcomes in patients with gastric cancer: exploratory analysis of a randomized controlled JCOG1001 trial. Gastric Cancer 2021;24:214-223. https://doi.org/10.1007/s10120-020-01102-3
  13. Kim SH, Ahn JH, Yoon HJ, Kim JH, Hwang YM, Choi YS, et al. Effect of a polyglycolic acid mesh sheet (NeoveilTM) in thyroid cancer surgery: a prospective randomized controlled trial. Cancers (Basel) 2022;14:3901.
  14. Takimoto K, Matsuura N, Nakano Y, Tsuji Y, Takizawa K, Morita Y, et al. Efficacy of polyglycolic acid sheeting with fibrin glue for perforations related to gastrointestinal endoscopic procedures: a multicenter retrospective cohort study. Surg Endosc 2022;36:5084-5093. https://doi.org/10.1007/s00464-021-08873-5
  15. Kabuto T, Omasa M, Nagata S, Tokushige K, Adachi T, Nakanishi T, et al. The effect of polyglycolic acid sheet in preventing postoperative recurrent pneumothorax: a prospective cohort study. J Cardiothorac Surg 2023;18:13.
  16. Shibutani M, Fukuoka T, Iseki Y, Kasashima H, Maeda K. Efficacy of the polyglycolic acid sheet for preventing anastomotic leakage in double-stapling technique anastomosis for left-sided colon or rectal cancer surgery: a propensity score-matched study. BMC Surg 2023;23:135.
  17. Jang JY, Shin YC, Han Y, Park JS, Han HS, Hwang HK, et al. Effect of polyglycolic acid mesh for prevention of pancreatic fistula following distal pancreatectomy: a randomized clinical trial. JAMA Surg 2017;152:150-155. https://doi.org/10.1001/jamasurg.2016.3644
  18. Shibuya K, Jang JY, Satoi S, Sho M, Yamada S, Kawai M, et al. The efficacy of polyglycolic acid felt reinforcement in preventing postoperative pancreatic fistula after pancreaticojejunostomy in patients with main pancreatic duct less than 3 mm in diameter and soft pancreas undergoing pancreatoduodenectomy (PLANET-PJ trial): study protocol for a multicentre randomized phase III trial in Japan and Korea. Trials 2019;20:490.
  19. Iwasaki K, Barroga E, Enomoto M, Matsumoto M, Yamada E, Miyoshi K, et al. Use of polyglycolic acid sheets for the prevention of pancreatic fistula after laparoscopic gastrectomy: a single-center retrospective study. Am Surg 2022;89:5318-5324.
  20. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 2021;24:1-21. https://doi.org/10.1007/s10120-020-01042-y
  21. Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, et al. "Pancreas-Compressionless Gastrectomy": a novel laparoscopic approach for suprapancreatic lymph node dissection. Ann Surg Oncol 2017;24:3331-3337. https://doi.org/10.1245/s10434-017-5974-4
  22. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011;14:101-112. https://doi.org/10.1007/s10120-011-0041-5
  23. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
  24. Takagi T, Tsujimoto H, Torii H, Ozamoto Y, Hagiwara A. New polyglycolic acid fabric for the prevention of postoperative pancreatic fistulas. Asian J Surg 2018;41:59-64. https://doi.org/10.1016/j.asjsur.2016.08.001
  25. Tsutsumi N, Tomikawa M, Akahoshi T, Kawanaka H, Ota M, Sakaguchi Y, et al. Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis: effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications. Am J Surg 2016;212:882-888. https://doi.org/10.1016/j.amjsurg.2015.12.028
  26. Hiura Y, Takiguchi S, Yamamoto K, Kurokawa Y, Yamasaki M, Nakajima K, et al. Use of fibrin glue sealant with polyglycolic acid sheets to prevent pancreatic fistula formation after laparoscopic-assisted gastrectomy. Surg Today 2013;43:527-533. https://doi.org/10.1007/s00595-012-0253-2
  27. Seo HS, Shim JH, Jeon HM, Park CH, Song KY. Postoperative pancreatic fistula after robot distal gastrectomy. J Surg Res 2015;194:361-366. https://doi.org/10.1016/j.jss.2014.10.022
  28. Katai H, Mizusawa J, Katayama H, Kunisaki C, Sakuramoto S, Inaki N, et al. Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401. Gastric Cancer 2019;22:999-1008. https://doi.org/10.1007/s10120-019-00929-9
  29. Fujiya K, Kumamaru H, Fujiwara Y, Miyata H, Tsuburaya A, Kodera Y, et al. Preoperative risk factors for postoperative intra-abdominal infectious complication after gastrectomy for gastric cancer using a Japanese web-based nationwide database. Gastric Cancer 2021;24:205-213. https://doi.org/10.1007/s10120-020-01083-3
  30. Gong S, Li X, Tian H, Song S, Lu T, Jing W, et al. Clinical efficacy and safety of robotic distal gastrectomy for gastric cancer: a systematic review and meta-analysis. Surg Endosc 2022;36:2734-2748. https://doi.org/10.1007/s00464-021-08994-x
  31. Li ZY, Zhou YB, Li TY, Li JP, Zhou ZW, She JJ, et al. Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a multicenter cohort study of 5402 patients in China. Ann Surg 2023;277:e87-e95.
  32. Kinoshita T, Uyama I, Terashima M, Noshiro H, Nagai E, Obama K, et al. Long-term outcomes of laparoscopic versus open surgery for clinical stage II/III gastric cancer: a multicenter cohort study in Japan (LOC-A study). Ann Surg 2019;269:887-894. https://doi.org/10.1097/SLA.0000000000002768
  33. Shimizu D, Tanaka C, Kanda M, Nakanishi K, Ito S, Kuwatsuka Y, et al. A multicenter randomized phase II trial investigating the effect of polyglycolic acid sheet on the prevention of pancreatic fistula after gastrectomy with prophylactic lymph node dissection. Clin Exp Gastroenterol 2023;16:169-172. https://doi.org/10.2147/CEG.S421531