Annual Report 2023
Department of Gastric Surgery
Takahiro Kinoshita, Masahiro Yura, Mitsumasa Yoshida, Takafumi Okayama, Takumi Habu, Hiromi Nagata, Masaru Komatsu, Daiki Terajima, Kiyotaka Mochizuki, Junichi Sano
Introduction
Our department consists of two staff surgeons and eight junior surgeons. Our managing of tumors includes common gastric adenocarcinoma, adenocarcinoma of the esophagogastric junction (AEG: Siewert type 2/3), and gastric submucosal tumors (GIST, etc.). In 2023, we performed gastrectomy on 248 patients, either using open surgery, laparoscopic or robotic surgery (Table 1). Laparoscopic gastrectomy was introduced in 2010, while robot-assisted gastrectomy was implemented in 2014. This year, more than 95% of gastrectomy was performed under laparoscopy (30%) or was robot-assisted (65%) (Table 2). The basis of our surgery is radical extirpation of cancer lesions with nodal dissection, but at the same time, organ functions and better quality of life (QOL) should be maintained. In addition, we strive to obtain better clinical outcomes for patients with diseases with dismal prognoses (type 4 gastric cancer or with progressive metastasis) through surgery combined with a modern perioperative chemotherapy in cooperation with medical oncologists.
The Team and What We Do
Usually, 10-14 patients are hospitalized and five to seven patients undergo operations per week. Our department conducts clinical conferences weekly to decide on our treatment strategies. Further, a conference with internal medicine is held weekly including doctors from Medical Oncology and Gastrointestinal Endoscopy, to discuss accurate diagnosis of the patients to decide the optimal treatment method. Robot/laparoscopic surgery covers distal, proximal, pylorus-preserving, and total gastrectomy. D2 dissection can also be performed, with indication extending to locally advanced cancer or cancer after NAC. Recently, due to the progress of chemotherapy regimen, down-staging from cStageIV is sometimes seen. For such patients, we selectively perform conversion surgery to achieve favorable outcomes. For AEGs, the transhiatal approach or thoraco-laparoscopic Ivor-Lewis surgery can be performed by minimally invasive means.
Research Activities
We aggressively publish our clinical research data at domestic or international congresses. In addition, we participate in multi-institutional clinical trials conducted by the Japan Clinical Oncology Group (JCOG) – Gastric Surgery Study Group or other international and domestic organizations, and work as PI for some clinical trials (JCOG1809) (COSMOS-GC, MONSTAR-3 regarding liquid biopsy). We have started investigating the auto intelligence technology relevant to laparoscopic or robot-assisted surgery.
Clinical Trials
The ongoing list of multi-institutional clinical trials we participate in is shown below.
1) JCOG1809 Single-arm phase II trial to evaluate safety of Laparoscopic Total Gastrectomy with Spleen-PReservING splenic hilar dissection for proximal gastric cancer invading the greater curvature (LTG-SPRING-PII)
2) JCOG1509 Phase III trial to evaluate the efficacy of neoadjuvant chemotherapy with S-1 plus oxaliplatin followed by D2 gastrectomy with adjuvant S-1 in locally advanced gastric cancer (NAGISA trial)
3) JCOG1711 Randomised controlled phase III trial to evaluate Omentum preserving gastrectomy for patients with ADvanced Gastric Cancer (ROAD-GC)
4) JCOG1907 Randomized controlled phase III trial to investigate superiority of robot-assisted gastrectomy over laparoscopic gastrectomy for clinical stage T1-2N0-2 Gastric Cancer patients (MONA-LISA Study)
5) JCOG2204 A randomized phase II study to compare the pathological responses of neoadjuvant chemotherapy for type 4 or large type 3 gastric cancer: 5-FU, Oxaliplatin and Docetaxel (FLOT) versus Docetaxel, Oxaliplatin and S-1(DOS)
6) An open label phase 2 study to evaluate the safety and efficacy of lenvatinib with pembrolizumab in the neoadjuvant / adjuvant treatment for patients with gastric cancer (EPOC2001)
7) An open label phase 2 study to evaluate the efficacy and safety of trastuzumab deruxtecan (T-DXd) in the neoadjuvant treatment for patients with HER2 positive gastric and gastroesophageal junction adenocarcinoma (EPOC2003)
8) Multiomics data cancer diagnostics therapies (TITANIA Study)
9) Conquer Solid Malignancies by blood screening –gastric cancer- 01 (COSMOS-GC)
10) Development of a Clinical Decision Support System (CDSS) with Artificial Intelligence for Gastric and Esophageal Adenocarcinomas (Ask Bob Study)
11) The HOLD Study– StomacH Cancer Elective Surgery MOrbidity and Mortality at 90-Day / The OUTLIVE Study - Oesophageal and JUncTional Cancer ELectIVE Surgery Morbidity and Mortality at 90-Day: A TUGS Multinational Audit
12) The UGIRA International Registry for Robot-Assisted Minimally Invasive Gastrectomy (RAMIG) for gastric cancer
13) The UGIRA International Registry for Robot-Assisted Minimally Invasive Esophagectomy (RAMIE)
14) A Study on the Learning Curve of the Multi-Jointed Articulating Laparoscopic Instrument (ArtiSential)
Education
Resident doctors are trained to become specialized surgical oncologists with sufficient techniques and knowledge. Nowadays, these doctors are given opportunities to perform laparoscopic/open/robotic surgeries. We also place importance on the education of surgeons from other institutions. In 2023, a total of 23 doctors from 10 countries visited us and stayed for several months for surgery observations, and one Italian doctor took the advanced clinical training program in our department which was officially approved by the Japanese government. In addition, we are endorsed as an official certified institution for surgery observation of robotic gastrectomy, and 42 people including doctors, nurses, and medical engineers participated in this program through the year.
Future Prospects
We will keep striving to obtain better survival outcomes for patients with far-advanced diseases; for multidisciplinary therapy (chemotherapy, molecular-target agents or immune oncology agents), collaborating with medical oncologists is essential. Additionally, we will continue to develop less-invasive surgical methods (laparoscopic or robotic surgery), to improve patients’ QOL and achieve complete cures. It is also our obligation to expand our knowledge and experience globally as one of the main countries in terms of incidence of gastric cancer.
List of papers published in 2023
Journal
1. Kunisaki C, Katai H, Sakuramoto S, Mizusawa J, Katayama H, Kadoya S, Yamada T, Kinoshita T, Yoshikawa T, Terashima M. A nonrandomized controlled trial: long-term outcomes of LATG/LAPG for cStage I gastric cancer: Japan Clinical Oncology Group Study JCOG1401. Gastric cancer, 27:164-175, 2024
2. Tokunaga M, Machida N, Mizusawa J, Ito S, Yabusaki H, Hirao M, Watanabe M, Imamura H, Kinoshita T, Yasuda T, Hihara J, Fukuda H, Yoshikawa T, Boku N, Terashima M. Early endpoints of a randomized phase II trial of preoperative chemotherapy with S-1/CDDP with or without trastuzumab followed by surgery for HER2-positive resectable gastric or esophagogastric junction adenocarcinoma with extensive lymph node metastasis: Japan Clinical Oncology Group study JCOG1301C (Trigger Study). Gastric cancer, 27:580-589, 2024
3. de Jongh C, Cianchi F, Kinoshita T, Kingma F, Piccoli M, Dubecz A, Kouwenhoven E, van Det M, Mala T, Coratti A, Ubiali P, Turner P, Kish P, Borghi F, Immanuel A, Nilsson M, Rouvelas I, Hﾓｧlzen JP, Rouanet P, Saint-Marc O, Dussart D, Patriti A, Bazzocchi F, van Etten B, Haveman JW, DePrizio M, Sabino F, Viola M, Berlth F, Grimminger PP, Roviello F, van Hillegersberg R, Ruurda J. Surgical Techniques and Related Perioperative Outcomes After Robot-assisted Minimally Invasive Gastrectomy (RAMIG): Results From the Prospective Multicenter International Ugira Gastric Registry. Annals of surgery, 280:98-107, 2024
4. Komatsu M, Kitaguchi D, Yura M, Takeshita N, Yoshida M, Yamaguchi M, Kondo H, Kinoshita T, Ito M. Automatic surgical phase recognition-based skill assessment in laparoscopic distal gastrectomy using multicenter videos. Gastric cancer, 27:187-196, 2024
5. Honda M, Ri M, Kinoshita T, Kawakubo H, Aizawa M, Bamba T, Matsuda S, Kawamura H, Yoshida M, Nunobe S. Comparison of the survival outcomes between retrocolic and antecolic Roux-en-Y reconstruction after gastrectomy for gastric cancer. Annals of gastroenterological surgery, 8:443-449, 2024
6. Makuuchi R, Terashima M, Terada M, Mizusawa J, Kita R, Tokunaga M, Omori T, Ojima T, Ehara K, Watanabe M, Yanagimoto Y, Nunobe S, Kinoshita T, Ito S, Nishida Y, Hihara J, Boku N, Kurokawa Y, Yoshikawa T. Randomized controlled phase III trial to investigate superiority of robot-assisted gastrectomy over laparoscopic gastrectomy for clinical stage T1-4aN0-3 gastric cancer patients (JCOG1907, MONA LISA study): a study protocol. BMC cancer, 23:987, 2023
7. Komatsu M, Kinoshita T, Akimoto E, Yoshida M, Nagata H, Habu T, Okayama T, Yura M. Advantages of robotic gastrectomy for overweight patients with gastric cancer: a comparison study of robotic gastrectomy and conventional laparoscopic gastrectomy. Surgery today, 53:1260-1268, 2023
8. Kinoshita T, Komatsu M. Artificial Intelligence in Surgery and Its Potential for Gastric Cancer. Journal of gastric cancer, 23:400-409, 2023
9. Mitsui T, Mori A, Takamatsu T, Kadota T, Sato K, Fukushima R, Okubo K, Umezawa M, Takemura H, Yokota H, Kuwata T, Kinoshita T, Ikematsu H, Yano T, Maeda S, Soga K. Evaluating the identification of the extent of gastric cancer by over-1000 nm near-infrared hyperspectral imaging using surgical specimens. Journal of biomedical optics, 28:086001, 2023