Skip to main content

Main menu

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
    • Special Issues 2025
  • Journal Metrics
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics

User menu

  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart

Search

  • Advanced search
Anticancer Research
  • Other Publications
    • Anticancer Research
    • In Vivo
    • Cancer Genomics & Proteomics
  • Register
  • Subscribe
  • My alerts
  • Log in
  • My Cart
Anticancer Research

Advanced Search

  • Home
  • Current Issue
  • Archive
  • Info for
    • Authors
    • Editorial Policies
    • Subscribers
    • Advertisers
    • Editorial Board
    • Special Issues 2025
  • Journal Metrics
  • Other Publications
    • In Vivo
    • Cancer Genomics & Proteomics
    • Cancer Diagnosis & Prognosis
  • More
    • IIAR
    • Conferences
    • 2008 Nobel Laureates
  • About Us
    • General Policy
    • Contact
  • Visit us on Facebook
  • Follow us on Linkedin
Research ArticleClinical Studies

Differences Between Laparoscopic and Open Gastrectomy on the Impact of Postoperative Infectious Complications on Prognosis

HIROMI NAGATA, HIRONORI TSUJIMOTO, KEITA KOUZU, YUJIRO ITAZAKI, YUSUKE ISHIBASHI, SATOSHI TSUCHIYA, TAKAO SUGIHARA, NOZOMI ITO, MANABU HARADA, SHINSUKE NOMURA, YOJI KISHI and HIDEKI UENO
Anticancer Research December 2020, 40 (12) 7109-7117; DOI: https://doi.org/10.21873/anticanres.14740
HIROMI NAGATA
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
HIRONORI TSUJIMOTO
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: tsujihi@ndmc.ac.jp
KEITA KOUZU
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
YUJIRO ITAZAKI
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
YUSUKE ISHIBASHI
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
SATOSHI TSUCHIYA
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
TAKAO SUGIHARA
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
NOZOMI ITO
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
MANABU HARADA
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
SHINSUKE NOMURA
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
YOJI KISHI
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
HIDEKI UENO
From the Department of Surgery, National Defense Medical College, Tokorozawa, Japan
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

Background/Aim: The aim of this study was to evaluate the impact of laparoscopic gastrectomy (LG) for gastric cancer on long-term survival in patients with postoperative infectious complications (PIC). Patients and Methods: A total of 608 patients who underwent gastrectomy were classified into two groups based on the surgical approach: LG (385 patients) and open gastrectomy (OG: 211 patients). Long-term survival after gastrectomy was compared between patients with and without PIC in both LG and OG groups. Results: Although the patients with PIC in OG group tended to have worse overall survival (OS) than those without PIC, the OS was not significantly different between the patients with and without PIC in LG group. Although multivariate analysis demonstrated that nodal involvement and PIC were significantly associated with OS in OG group, age and tumor depth, and not PIC, were associated with OS in LG group. Conclusion: PIC were negative predictors of clinical outcomes in patients with gastric cancer, particularly those who underwent OG, and long-term prognosis may be impacted less by PIC in patients undergoing LG.

Key Words:
  • Minimal invasive surgery
  • gastric cancer
  • postoperative infectious complications
  • surgical stress
  • prognosis

Albeit considerable advances in prevention, diagnosis, and therapy for postoperative infections, morbidity rates following gastrectomy with D2 lymphadenectomy range between 19.6% and 26.2% worldwide (1, 2). Postoperative infectious complications (PIC) increase the cost of treatment, delay adequate adjuvant therapy, affect quality of life, and may be associated with poor prognosis (3, 4). In addition, increasing evidence suggest that PIC are significantly associated with negative long-term outcomes in various malignancies (5-10).

Minimal invasive surgery for gastrointestinal cancers has recently become prevalent. The noninferiority of laparoscopic gastrectomy (LG) over conventional open gastrectomy (OG) for long-term outcomes has been reported previously (11). We recently demonstrated that less invasive surgery was associated with reduced postoperative inflammatory responses compared to conventional open surgery (12, 13). However, none of the studies to date have assessed the surgical invasiveness of gastrectomy on the poor long-term survival associated with PIC in gastric cancer.

We hypothesized that the difference in surgical approach had a distinct effect on long-term outcomes in patients with PIC. However, it is apparent that LG may be performed at an earlier stage of gastric cancer as compared with conventional OG. To that end, we investigated the impact of differences in surgical approaches for gastrectomy on long-term outcomes after a potentially curative resection for gastric cancer in patients with PIC according to the stage of disease.

Patients and Methods

Patients. Between 2009 and 2016, 787 consecutive patients underwent gastrectomy for adenocarcinoma of the stomach at National Defense Medical College Hospital (Tokorozawa, Saitama, Japan). Among these, 596 patients (455 males, 141 females; mean age, 69.0±0.4 years; range=32-92 years) who underwent gastrectomy with potentially curative resection were included in the current study. Two hundred eleven patients underwent open gastrectomy and 365 patients underwent laparoscopic gastrectomy. We excluded patients who underwent R1 or R2 surgery, those who underwent pancreatosplenectomy, those who underwent gastrectomy for benign diseases or gastrointestinal stromal tumors, those who received preoperative chemotherapy, those with in-hospital mortality, and those with an observation period of 100 days or less. The resected specimens were examined histopathologically and staged according to the third English edition of the Japanese Classification of Gastric Carcinoma (14). Adjuvant chemotherapy with oral anti-cancer agents such as fluoropyrimidine (S-1), was recommended in patients with stage II or III gastric cancer. Seven patients in the study cohort had early gastric cancer with incomplete D1 lymphadenectomy (D0) with sentinel node navigation surgery, which was a potentially curative resection. These patients were retrospectively evaluated for their pre- and post-operative status, pathological findings, and surgical procedures based on the data in the electronic records or medical and nursing charts.

This is a non-randomized, retrospective and single institutional study. LG has been introduced since 2007, and the indication of LG was a tumor depth of cT2 or less regardless of any lymph node metastasis until 2010, which was expanded in 2011 to a tumor depth of cT4a regardless of any lymph node metastasis.

All procedures were in accordance with the Helsinki Declaration of 1964 and later versions. The study protocol was approved by the Institutional Review Board of the National Defense Medical College. Written informed consent was obtained from every patient before the procedures.

Definition of infectious complications. Complications due to postoperative infections were defined based on the combination of clinical findings and results of laboratory and other tests recorded in the medical records. Clinical evidence was derived from direct observation of the infection site or from review of the patient’s chart. Laboratory evidence included culture results, antigen or antibody detection tests, and analysis by microscopic visualization. Supportive data were derived from other diagnostic studies, such as X-ray, ultrasonography (US), and computed tomography (CT). In the present study, PIC included pneumonia (pyrexia with infiltrates on chest X-ray), enterocolitis (pyrexia with diarrhea and microbiological evidence), cholecystitis (pyrexia with wall thickness diagnosed by US or CT), anastomotic leakage (identified radiographically or clinical suspicion), urinary tract infection (pyrexia with positive culture results) and intraperitoneal abscess, such as pancreatic fistula and other systemic infections (pyrexia with fluid collection diagnosed by US or CT or identified radiographically). Other included infections were central venous catheter-related infections and sepsis. Superficial wound infections were excluded from the study analysis because of their minimal effect on the systemic immune response. In this study, PIC were included if more than grade 3 based on Clavien-Dindo classification (15).

Follow-up. Overall survival (OS) was based on the time interval from the date of resection to the date of death due to any cause. Relapse-free survival (RFS) was based on the time interval from the date of resection to the date of first recurrence or death. Patients who survived were censored in the survival analyses. All patients were observed at the study hospital or the outpatient clinic at 3-4-month intervals during the first two years of the study and every 6 or 12 months thereafter for three years. After 5 years, annual follow-up was performed via telephone conversations with the patient, patient’s family, or their practitioner.

Statistical analysis. Statistical analyses were performed using JMP Pro 14.0.0 (SAS Institute, Cary, NC, USA). Data were expressed as means±standard error of the mean. Statistical analyses were performed using either the Mann-Whitney U test or the chi-square test with Fisher’s exact test, as appropriate. Survival rates were determined using the Kaplan–Meier method, and the significance of differences in survival rate was determined by the log-rank test. p-Values <0.05 were considered statistically significant.

Results

The demographic and clinicopathological data of the study cohort are shown in Table I. The tumor sizes were larger, upper stomach was the most frequent tumor location, and tumor invasion was deeper in the patients who underwent OG compared with those who underwent LG. Additionally, the frequencies of nodal involvement, more advanced stage of disease, total gastrectomy, D2 lymphadenectomy, and resection of other organs were higher in the OG group than the LG group. Shorter operating times, higher blood loss, blood transfusions, longer hospital stays, and PIC were more frequent in the OG group than the LG group.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table I.

Demographic and clinicopathological data of patients who underwent open gastrectomy or laparoscopic gastrectomy.

The demographic and clinicopathological data of patients with or without PIC are presented in Table II. There were no differences in age, sex, body mass index, tumor location, tumor depth, nodal involvement, or stage between patients who underwent LG and OG. However, the rates of total gastrectomy, D2 lymphadenectomy, and combined resection of other organs were higher in patients who underwent OG compared to those who underwent LG among both the patients with and without PIC. In addition, the patients who underwent OG had shorter operating times and higher blood loss, and received blood transfusions more frequently. The patients who underwent OG had significantly longer postoperative hospital stays than those who underwent LG among the patients without PIC, but the postoperative hospital stay did not differ among the patients with PIC. The types and frequencies of PIC are depicted in Table III. The patients who underwent OG had pancreatic fistula and anastomotic leakage more frequently than those who underwent LG.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table II.

Demographic and clinicopathological characteristics of patients with or without postoperative infectious complications who underwent open gastrectomy or laparoscopic gastrectomy.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table III.

Type and frequencies of postoperative infectious complications.

The main recurrence sites in LG and OG groups are shown in Table IV. There were no differences in the main recurrence sites between the OG and the LG groups and between patients with and without PIC.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table IV.

Main recurrence site in patients with or without postoperative infectious complications.

The median follow-up of surviving patients was 1,574 days (range=113-3,502 days). There were significant differences in both the RFS and OS between the patients with and without PIC among those who underwent OG as well as those who underwent LG (Figure 1). Next, we compared the prognosis only in patients with Stage II and III gastric cancer because of extremely favorable and unfavorable outcomes in Stage I and IV gastric cancer, respectively (Figure 2). Although the patients with PIC among those who underwent OG tended to have worse RFS and OS than those without PIC, the RFS and OS were not significantly different between the patients with and without PIC in the LG group.

Figure 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 1.

RFS and OS after potentially curative gastrectomy in patients with or without PIC according to the surgical approach. RFS: Relapse-free survival; OS: overall survival; PIC: postoperative infectious complications.

Figure 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Figure 2.

RFS and OS after potentially curative gastrectomy in patients with or without PIC in patients with stage II or III gastric cancer. RFS: Relapse-free survival; OS: overall survival; PIC: postoperative infectious complications.

In the univariate analysis, age, sex, BMI, tumor location, tumor size, blood transfusion, tumor depth, nodal involvement, and PIC significantly affected OS in all patients (Table V), and multivariate analysis demonstrated that age, BMI, and PIC were significantly associated with OS in this cohort. Although multivariate analysis demonstrated that nodal involvement and PIC were significantly associated with OS in patients undergoing OG, age and tumor depth, but not PIC, were associated with OS in patients undergoing LG.

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table V.

Univariate and multivariate analyses of factors that may affect overall survival.

Discussion

In this first report assessing the association of the type of gastrectomy for gastric cancer with PIC, PIC were negative predictors of clinical outcomes in patients with gastric cancer, particularly those who underwent OG, and the long-term prognosis may be impacted less by PIC in patients undergoing minimally invasive surgery, i.e. LG, as shown in multivariate and propensity score matching analyses.

Many reports have previously demonstrated a significant increase in long-term mortality in association with PIC (16-19). However, the precise mechanism underlying the relationship between long-term survival and PIC remains unclear. We previously suggested two possible mechanisms (8). First, enhancement of biological factors during infection or those produced by infection-causing bacteria may directly promote cancer cell proliferation and metastasis. For example, cytokines, oxygen free radicals, and lipopolysaccharides were implicated in promoting cancer cell growth (20-26). Second, dysregulated host immune response during infection may also contribute to tumorigenesis. Khuri et al. demonstrated an important independent predictive role for postoperative complications on both short- and long-term survival after major surgery (27). In that study, myocardial infarction and pneumonia, but not wound infection, consistently exhibited a significant effect on long-term survival, suggesting that the long-term survival after surgery might depend on the degree of systemic immune response to the infection.

Systemic infection and sepsis were demonstrated to induce the systemic inflammatory response syndrome and lead to a period of immunosuppression, which is especially enhanced after surgical trauma (28-30). Relatedly, the “second attack” theory of multiple system organ failure (31) proposes that a severe insult in the form of infection or trauma primes the host immune system so that a subsequent, relatively trivial insult, produces a markedly exaggerated host immune response. This second attack hypothesis is being increasingly recognized as an important cause of morbidity and mortality following surgery and sepsis. Ogawa described that the term “second attack” is critically important for the prevention of organ dysfunction, because while surgeons cannot control the first insult, they can prevent or reduce the impact of the second attack (31). However, minimal invasive surgery, already utilized extensively, can reduce the impact of the first insult in the form of surgical trauma. Contrary to the concept of the second attack, prior exposure of innate immune cells, such as macrophages, to minute amounts of endotoxins promote their refractoriness to subsequent endotoxin challenges, a phenomenon termed “endotoxin tolerance” (32). These conflicting responses may arise from differences in the degree and/or content of the initial insult. In that regard, it is reasonable to expect that the difference in the degree of surgical invasiveness during gastrectomy will affect the biological response after PIC and the unfavorable outcomes associated with PIC.

Although many prospective studies aimed to determine whether minimally invasive surgical approaches such as endoscopic or robotic surgery contribute to the oncological prognosis compared to conventional open surgery, the results remain controversial (33, 34). One potential explanation is that the incidence of PIC and their effect on long-term prognosis are not always considered.

In conclusion, our findings indicate that PIC are useful predictors of adverse clinical outcomes in patients with gastric cancer, particularly those undergoing open surgery, and that the long-term prognosis of patients undergoing minimally invasive surgery might be impacted less by PIC. The current study did not demonstrate any differences in postoperative biological parameters such as serum cytokine levels between the two groups, which is a limitation of the study; further studies evaluating immunological parameters and cytokine levels will be essential to elucidate the mechanism underlying the current findings. Future prospective trials are required to investigate whether differential surgical approaches are associated with differences in long-term prognosis in association with postoperative complications due to infections.

Footnotes

  • Authors’ Contributions

    Dr. Hiromi Nagata and Dr. Hironori Tsujimoto conceived the idea of this research, designed the protocol, and supervised the analysis of the results. Yoshihisa Yaguchi, Keita Kouzu, Yujiro Itazaki, Yusuke Ishibashi, Satoshi Tsuchiya, Takao Sugihara, Nozomi Ito, Manabu Harada, Shinsuke Nomura developed and supervised all works and analyzed the results. Dr. Yoji Kishi and Hideki Ueno supervised the study.

  • Conflicts of Interest

    All Authors (Hiromi Nagata, Hironori Tsujimoto, Yoshihisa Yaguchi, Keita Kouzu, Yujiro Itazaki, Yusuke Ishibashi, Satoshi Tsuchiya, Takao Sugihara, Nozomi Ito, Manabu Harada, Shinsuke Nomura, Yoji Kishi, Hideki Ueno) report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

  • Received October 6, 2020.
  • Revision received October 17, 2020.
  • Accepted October 19, 2020.
  • Copyright © 2020 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

References

  1. ↵
    1. Jeong O,
    2. Kyu Park Y,
    3. Ran Jung M and
    4. Yeop Ryu S
    : Analysis of 30-day postdischarge morbidity and readmission after radical gastrectomy for gastric carcinoma: a single-center study of 2107 patients with prospective data. Medicine (Baltimore) 94(11): e259, 2015. PMID: 25789945. DOI: 10.1097/MD.0000000000000259
    OpenUrlCrossRef
  2. ↵
    1. Watanabe M,
    2. Miyata H,
    3. Gotoh M,
    4. Baba H,
    5. Kimura W,
    6. Tomita N,
    7. Nakagoe T,
    8. Shimada M,
    9. Kitagawa Y,
    10. Sugihara K and
    11. Mori M
    : Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg 260(6): 1034-1039, 2014. PMID: 25072429. DOI: 10.1097/SLA.0000000000000781
    OpenUrlCrossRef
  3. ↵
    1. Collins TC,
    2. Daley J,
    3. Henderson WH and
    4. Khuri SF
    : Risk factors for prolonged length of stay after major elective surgery. Ann Surg 230(2): 251-259, 1999. PMID: 10450740. DOI: 10.1097/00000658-199908000-00016
    OpenUrlCrossRefPubMed
  4. ↵
    1. Tsutsui S,
    2. Moriguchi S,
    3. Morita M,
    4. Kuwano H,
    5. Matsuda H,
    6. Mori M,
    7. Matsuura H and
    8. Sugimachi K
    : Multivariate analysis of postoperative complications after esophageal resection. Ann Thorac Surg 53(6): 1052-1056, 1992. PMID: 1596128. DOI: 10.1016/0003-4975(92)90388-k
    OpenUrlCrossRefPubMed
  5. ↵
    1. Nowacki MP and
    2. Szymendera JJ
    : The strongest prognostic factors in colorectal carcinoma. Surgicopathologic stage of disease and postoperative fever. Dis Colon Rectum 26(4): 263-268, 1983. PMID: 6839898. DOI: 10.1007/BF02562495
    OpenUrlCrossRefPubMed
    1. Hirai T,
    2. Yamashita Y,
    3. Mukaida H,
    4. Kuwahara M,
    5. Inoue H and
    6. Toge T
    : Poor prognosis in esophageal cancer patients with postoperative complications. Surg Today 28(6): 576-579, 1998. PMID: 9681604. DOI: 10.1007/s005950050187
    OpenUrlCrossRefPubMed
    1. Shimada H,
    2. Fukagawa T,
    3. Haga Y and
    4. Oba K
    : Does postoperative morbidity worsen the oncological outcome after radical surgery for gastrointestinal cancers? A systematic review of the literature. Ann Gastroenterol Surg 1(1): 11-23, 2017. PMID: 29863169. DOI: 10.1002/ags3.12002
    OpenUrlCrossRef
  6. ↵
    1. Tsujimoto H,
    2. Ichikura T,
    3. Ono S,
    4. Sugasawa H,
    5. Hiraki S,
    6. Sakamoto N,
    7. Yaguchi Y,
    8. Yoshida K,
    9. Matsumoto Y and
    10. Hase K
    : Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Ann Surg Oncol 16(2): 311-318, 2009. PMID: 19037699. DOI: 10.1245/s10434-008-0249-8
    OpenUrlCrossRefPubMed
    1. Tsujimoto H,
    2. Ueno H,
    3. Hashiguchi Y,
    4. Ono S,
    5. Ichikura T and
    6. Hase K
    : Postoperative infections are associated with adverse outcome after resection with curative intent for colorectal cancer. Oncol Lett 1(1): 119-125, 2010. PMID: 22966268. DOI: 10.3892/ol_00000022
    OpenUrlCrossRef
  7. ↵
    1. Hsueh SW,
    2. Liu KH,
    3. Hung CY,
    4. Tsai CY,
    5. Hsu JT,
    6. Tsang NM,
    7. Hsueh WH,
    8. Yang C and
    9. Chou WC
    : Predicting postoperative events in patients with gastric cancer: A comparison of five nutrition assessment tools. In Vivo 34(5): 2803-2809, 2020. PMID: 32871818. DOI: 10.21873/invivo.12106
    OpenUrlAbstract/FREE Full Text
  8. ↵
    1. Hiki N,
    2. Katai H,
    3. Mizusawa J,
    4. Nakamura K,
    5. Nakamori M,
    6. Yoshikawa T,
    7. Kojima K,
    8. Imamoto H,
    9. Ninomiya M,
    10. Kitano S and
    11. Terashima M
    : Long-term outcomes of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG0703). Gastric Cancer 21: 155-161, 2018. PMID: 28093654. DOI: 10.1007/s10120-016-0687-0
    OpenUrlCrossRef
  9. ↵
    1. Tsujimoto H,
    2. Takahata R,
    3. Nomura S,
    4. Yaguchi Y,
    5. Kumano I,
    6. Matsumoto Y,
    7. Yoshida K,
    8. Horiguchi H,
    9. Hiraki S,
    10. Ono S,
    11. Yamamoto J and
    12. Hase K
    : Video-assisted thoracoscopic surgery for esophageal cancer attenuates postoperative systemic responses and pulmonary complications. Surgery 151(5): 667-673, 2012. PMID: 22244180. DOI: 10.1016/j.surg.2011.12.006
    OpenUrlCrossRefPubMed
  10. ↵
    1. Tsujimoto H,
    2. Ono S,
    3. Sugasawa H,
    4. Ichikura T,
    5. Yamamoto J and
    6. Hase K
    : Gastric tube reconstruction by laparoscopy-assisted surgery attenuates postoperative systemic inflammatory response after esophagectomy for esophageal cancer. World J Surg 34(12): 2830-2836, 2010. PMID: 20703457. DOI: 10.1007/s00268-010-0757-0
    OpenUrlCrossRefPubMed
  11. ↵
    1. Japanese Gastric Cancer Association
    : Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2): 101-112, 2011. PMID: 21573743. DOI: 10.1007/s10120-011-0041-5
    OpenUrlCrossRefPubMed
  12. ↵
    1. Dindo D,
    2. Demartines N and
    3. Clavien PA
    : Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2): 205-213, 2004. PMID: 15273542. DOI: 10.1097/01.sla.0000133083.54934.ae
    OpenUrlCrossRefPubMed
  13. ↵
    1. Lagarde SM,
    2. de Boer JD,
    3. ten Kate FJ,
    4. Busch OR,
    5. Obertop H and
    6. van Lanschot JJ
    : Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence. Ann Surg 247(1): 71-76, 2008. PMID: 18156925. DOI: 10.1097/SLA.0b013e31815b695e
    OpenUrlCrossRefPubMed
    1. Akyol AM,
    2. McGregor JR,
    3. Galloway DJ,
    4. Murray GD and
    5. George WD
    : Anastomotic leaks in colorectal cancer surgery: a risk factor for recurrence? Int J Colorectal Dis 6(4): 179-183, 1991. PMID: 1770281. DOI: 10.1007/BF00341385
    OpenUrlCrossRefPubMed
    1. Nespoli A,
    2. Gianotti L,
    3. Totis M,
    4. Bovo G,
    5. Nespoli L,
    6. Chiodini P and
    7. Brivio F
    : Correlation between postoperative infections and long-term survival after colorectal resection for cancer. Tumori 90(5): 485-490, 2004. PMID: 15656334.
    OpenUrlPubMed
  14. ↵
    1. Walker KG,
    2. Bell SW,
    3. Rickard MJ,
    4. Mehanna D,
    5. Dent OF,
    6. Chapuis PH and
    7. Bokey EL
    : Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 240(2): 255-259, 2004. PMID: 15273549. DOI: 10.1097/01.sla.0000133186.81222.08
    OpenUrlCrossRefPubMed
  15. ↵
    1. Tsujimoto H,
    2. Ono S,
    3. Ichikura T,
    4. Matsumoto Y,
    5. Yamamoto J and
    6. Hase K
    : Roles of inflammatory cytokines in the progression of gastric cancer: friends or foes? Gastric Cancer 13(4): 212-221, 2010. PMID: 21128056. DOI: 10.1007/s10120-010-0568-x
    OpenUrlCrossRefPubMed
    1. Dranoff G
    : Cytokines in cancer pathogenesis and cancer therapy. Nat Rev Cancer 4(1): 11-22, 2004. PMID: 14708024. DOI: 10.1038/nrc1252
    OpenUrlCrossRefPubMed
    1. Perwez Hussain S and
    2. Harris CC
    : Inflammation and cancer: an ancient link with novel potentials. Int J Cancer 121(11): 2373-2380, 2007. PMID: 17893866. DOI: 10.1002/ijc.23173
    OpenUrlCrossRefPubMed
    1. Smyth MJ,
    2. Cretney E,
    3. Kershaw MH and
    4. Hayakawa Y
    : Cytokines in cancer immunity and immunotherapy. Immunol Rev 202: 275-293, 2004. PMID: 15546400. DOI: 10.1111/j.0105-2896.2004.00199.x
    OpenUrlCrossRefPubMed
    1. Majima T,
    2. Ichikura T,
    3. Chochi K,
    4. Kawabata T,
    5. Tsujimoto H,
    6. Sugasawa H,
    7. Kuranaga N,
    8. Takayama E,
    9. Kinoshita M,
    10. Hiraide H,
    11. Seki S and
    12. Mochizuki H
    : Exploitation of interleukin-18 by gastric cancers for their growth and evasion of host immunity. Int J Cancer 118(2): 388-395, 2006. PMID: 16049975. DOI: 10.1002/ijc.21334
    OpenUrlCrossRefPubMed
    1. Sugasawa H,
    2. Ichikura T,
    3. Kinoshita M,
    4. Ono S,
    5. Majima T,
    6. Tsujimoto H,
    7. Chochi K,
    8. Hiroi S,
    9. Takayama E,
    10. Saitoh D,
    11. Seki S and
    12. Mochizuki H
    : Gastric cancer cells exploit CD4+ cell-derived CCL5 for their growth and prevention of CD8+ cell-involved tumor elimination. Int J Cancer 122(11): 2535-2541, 2008. PMID: 18246596. DOI: 10.1002/ijc.23401
    OpenUrlCrossRefPubMed
  16. ↵
    1. Chochi K,
    2. Ichikura T,
    3. Kinoshita M,
    4. Majima T,
    5. Shinomiya N,
    6. Tsujimoto H,
    7. Kawabata T,
    8. Sugasawa H,
    9. Ono S,
    10. Seki S and
    11. Mochizuki H
    : Helicobacter pylori augments growth of gastric cancers via the lipopolysaccharide-toll-like receptor 4 pathway whereas its lipopolysaccharide attenuates antitumor activities of human mononuclear cells. Clin Cancer Res 14(10): 2909-2917, 2008. PMID: 18483357. DOI: 10.1158/1078-0432.CCR-07-4467
    OpenUrlAbstract/FREE Full Text
  17. ↵
    1. Khuri SF,
    2. Henderson WG,
    3. DePalma RG,
    4. Mosca C,
    5. Healey NA and
    6. Kumbhani DJ
    : Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg 242(3): 326-341, 2005. PMID: 16135919. DOI: 10.1097/01.sla.0000179621.33268.83
    OpenUrlCrossRefPubMed
  18. ↵
    1. Aosasa S,
    2. Ono S,
    3. Mochizuki H,
    4. Tsujimoto H,
    5. Osada S,
    6. Takayama E Seki S and
    7. Hiraide H
    : Activation of monocytes and endothelial cells depends on the severity of surgical stress. World J Surg 24(1): 10-16, 2000. PMID: 10594196. DOI: 10.1007/s002689910003
    OpenUrlCrossRefPubMed
    1. Mokart D,
    2. Capo C,
    3. Blache JL,
    4. Delpero JR,
    5. Houvenaeghel G,
    6. Martin C and
    7. Mege JL
    : Early postoperative compensatory anti-inflammatory response syndrome is associated with septic complications after major surgical trauma in patients with cancer. Br J Surg 89(11): 1450-1456, 2002. PMID: 12390391. DOI: 10.1046/j.1365-2168.2002.02218.x
    OpenUrlCrossRefPubMed
  19. ↵
    1. Tsujimoto H,
    2. Ono S,
    3. Majima T,
    4. Efron PA,
    5. Kinoshita M,
    6. Hiraide H,
    7. Moldawer LL and
    8. Mochizuki H
    : Differential toll-like receptor expression after ex vivo lipopolysaccharide exposure in patients with sepsis and following surgical stress. Clin Immunol 119(2): 180-187, 2006. PMID: 16517212. DOI: 10.1016/j.clim.2006.01.004
    OpenUrlCrossRefPubMed
  20. ↵
    1. Ogawa M
    : Systemic inflammatory response syndrome—a concept for avoiding organ dysfunction induced by a “second attack”. Surg Today 28(7): 679-681, 1998. PMID: 9697258. DOI: 10.1007/BF02484611
    OpenUrlCrossRefPubMed
  21. ↵
    1. Seeley JJ and
    2. Ghosh S
    : Molecular mechanisms of innate memory and tolerance to LPS. J Leukoc Biol 101(1): 107-119, 2017. PMID: 27780875. DOI: 10.1189/jlb.3MR0316-118RR
    OpenUrlCrossRefPubMed
  22. ↵
    1. Athanasiou CD,
    2. Robinson J,
    3. Yiasemidou M,
    4. Lockwood S and
    5. Markides GA
    : Laparoscopic vs. open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes. Int J Surg 41: 78-85, 2017. PMID: 28344158. DOI: 10.1016/j.ijsu.2017.03.050
    OpenUrlCrossRef
  23. ↵
    1. Yoshida K,
    2. Honda M,
    3. Kumamaru H,
    4. Kodera Y,
    5. Kakeji Y,
    6. Hiki N,
    7. Etoh T,
    8. Miyata H,
    9. Yamashita Y,
    10. Seto Y,
    11. Kitano S and
    12. Konno H
    : Surgical outcomes of laparoscopic distal gastrectomy compared to open distal gastrectomy: A retrospective cohort study based on a nationwide registry database in Japan. Ann Gastroenterol Surg 2(1): 55-64, 2018. PMID: 29863131. DOI: 10.1002/ags3.12054
    OpenUrlCrossRef
PreviousNext
Back to top

In this issue

Anticancer Research: 40 (12)
Anticancer Research
Vol. 40, Issue 12
December 2020
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Back Matter (PDF)
  • Ed Board (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Anticancer Research.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Differences Between Laparoscopic and Open Gastrectomy on the Impact of Postoperative Infectious Complications on Prognosis
(Your Name) has sent you a message from Anticancer Research
(Your Name) thought you would like to see the Anticancer Research web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
6 + 12 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Differences Between Laparoscopic and Open Gastrectomy on the Impact of Postoperative Infectious Complications on Prognosis
HIROMI NAGATA, HIRONORI TSUJIMOTO, KEITA KOUZU, YUJIRO ITAZAKI, YUSUKE ISHIBASHI, SATOSHI TSUCHIYA, TAKAO SUGIHARA, NOZOMI ITO, MANABU HARADA, SHINSUKE NOMURA, YOJI KISHI, HIDEKI UENO
Anticancer Research Dec 2020, 40 (12) 7109-7117; DOI: 10.21873/anticanres.14740

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Reprints and Permissions
Share
Differences Between Laparoscopic and Open Gastrectomy on the Impact of Postoperative Infectious Complications on Prognosis
HIROMI NAGATA, HIRONORI TSUJIMOTO, KEITA KOUZU, YUJIRO ITAZAKI, YUSUKE ISHIBASHI, SATOSHI TSUCHIYA, TAKAO SUGIHARA, NOZOMI ITO, MANABU HARADA, SHINSUKE NOMURA, YOJI KISHI, HIDEKI UENO
Anticancer Research Dec 2020, 40 (12) 7109-7117; DOI: 10.21873/anticanres.14740
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Patients and Methods
    • Results
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Bone Toxicity Case Report Combining Encorafenib, Cetuximab and WNT974 in a Phase I Trial
  • Assessment of Breakthrough Cancer Pain Among Female Patients With Cancer: Knowledge, Management and Characterization in the IOPS-MS Study
  • Low-dose Apalutamide in Non-metastatic Castration-resistant Prostate Cancer: A Case Series
Show more Clinical Studies

Similar Articles

Keywords

  • Minimal invasive surgery
  • Gastric cancer
  • postoperative infectious complications
  • surgical stress
  • prognosis
Anticancer Research

© 2025 Anticancer Research

Powered by HighWire