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简介：Objective:Curativegastriccancersurgeryentailsremovaloftheprimarytumorwithadequatemarginsincludingregionallymphnodes.Europeanrandomizedcontrolledtrialswithrecruitmentinthe1990'sreportedincreasedmorbidityandmortalityforD2comparedtoD1.Here,weexaminedtheextentoflymphadenectomyduringgastriccancersurgeryandtheassociatedriskforpostoperativecomplicationsandmortalityusingthestrengthsofapopulation-basedstudy.Methods:AprospectivenationwidestudyconductedwithintheNationalRegisterofEsophagealandGastricCancer.AllpatientsinSwedenfrom2006to2013whounderwentgastriccancerresectionswithcurativeintentwereincluded.PatientswerecategorizedintoD0,D1,orD1+/D2,andanalyzedregardingpostoperativemorbidityandmortalityusingmultivariablelogisticregression.Results:Intotal,349(31.7%)patientshadaD0,494(44.9%)D1,and258(23.4%)D1+/D2lymphadenectomy.The30-dpostoperativecomplicationrateswere25.5%,25.1%and32.2%(D0,D1andD1+/D2,respectively),and90-dmortalityrateswere8.3%,4.3%and5.8%.Afteradjustmentforconfounders,inmultivariableanalysis,therewerenosignificantdifferencesinriskforpostoperativecomplicationsbetweenthelymphadenectomygroups.For90-dmortality,therewasalowerriskforD1vs.D0.Conclusions:ThemajorityofgastriccancerresectionsinSwedenhaveincludedonlyalimitedlymphadenectomy(D0andD1).Moreextensivelymphadenectomy(D1+/D2)seemedtohavenoimpactonpostoperativemorbidityormortality.

简介：Objective:Patientsundergoingtotalgastrectomyforcancerareatriskofmalnourishment.Theaimofthisselfcontrolledstudywastoexaminetheeffectofjejunostomytubefeeding(JTF)andotherfactorsonpostoperativeweightandtheincidenceofjejunostomy-relatedcomplicationsinpatientsundergoingtotalgastrectomyforcancer.Methods:Allconsecutivepatientswhounderwenttotalgastrectomyforgastriccancerwithjejunostomyplacementwereincludedfromaprospectivesingle-centerdatabase(2003–2014).Jejunostomy-relatedcomplicationsandpostoperativeweightchangeswereevaluatedupto12monthsaftersurgery.Multivariablelinearregressionanalysiswasperformedtoidentifyfactorsassociatedwithweightloss12monthsaftergastrectomy.Results:Of113patientsoperatedinthestudyperiod,65receivedJTFaftertotalgastrectomyforamediandurationof18d[interquartilerange(IQR),10–55d].Jejunostomy-relatedcomplicationsoccurredin11(17%)patients,includingskinleakage(n=3)andperitonealleakage(n=2),luxation(n=3),occlusion(n=2),infection(n=1)andtorsion(n=1).In2(3%)patients,areoperationwasneededduetojejunostomy-relatedcomplications.Themeanpreoperativeweightofpatientswas71.8kg(100%),andremainedstableduringJTF(73.9kg,103%,P=0.331).AfterJTFwasstopped,themeanweightofpatientsdecreasedto64.9kg(90%)at12monthsaftersurgery(P<0.001).Ahighpreoperativebodymassindex(BMI)(≥25kg/m~2)wasassociatedwithhighpostoperativeweightlosscomparedtopatientswithalowBMI(<25kg/m~2)(16.3%vs.8.6%,P=0.016).Conclusions:JTFcanpreventweightlossintheearlypostoperativephase.However,thisisattheprizeofpossiblecomplications.Asweightlossinthelongtermisnotprevented,routineJTFshouldbere-evaluatedandbalancedagainsttheselecteduseinpreoperativelymalnourishedpatients.SpecialattentionshouldbepaidtopatientswithahighpreoperativeBMI,whoareatriskofmorepostoperativeweightloss.