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Improving the outcomes in gastric cancer surgery

World Journal of Gastroenterology 2014年第38期20卷 13692-13704页

作者： juul jw tegels Michiel FG De Maat Karel WE Hulsewé Anton GM Hoofwijk Jan HMB Stoot Department of Surgery Orbis Medical Center Department of Surgery Maastricht University Medical Center Department of Surgery Atrium Medical Center

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 *** of fast-track or enhanced recovery after surgery programs is showing promising results,although future studies have to determine what the exact optimal strategy *** of laparoscopic surgery has shown improvement of results as well as optimization of lymph node *** intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus *** in postoperative care include optimal timing of oral diet,which has been shown to reduce hospital *** general,hospital volume,i.e.,centralization,and clinical audits might further improve the outcome in gastric cancer *** conclusion,progress has been made in improving the surgical treatment of gastric ***,gastric cancer treatment is high risk surgery and many areas for future research remain.

关键词： Gastric cancer Laparoscopic surgery Risk assessment Surgical outcome Postoperative care

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Way forward: Geriatric frailty assessment as risk predictor in gastric cancer surgery

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World Journal of Gastrointestinal Surgery 2015年第10期7卷 223-225页

作者： juul jw tegels Jan HMB Stoot Department of Surgery Atrium-Orbis Medical Centre

In gastric cancer patients chronological and biological age might vary greatly between patients. Age as well as American Society of Anaesthesiologists-physical status classifications are very non-specific and do not adequately predict adverse outcome. Improvements have been made such as the introduction of Charlson Comorbidity Index. Geriatric frailty is probably a better measure for patients resistance to stressors and physiological reserves. An increasing amount of evidence shows that geriatric frailty is a better predictor for adverse outcome after surgery, including gastric cancer surgery. Geriatric frailty can be assessed in a number of ways. Questionnaires such as the Groningen Frailty Indicator provide an ease and low cost method for gauging the presence of frailty in gastric cancer patients. This can then be used to provide a better preoperative risk assessment in these patients and improve decision making.

关键词： Gastric cancer Surgery Geriatric frailty

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