Vagus Nerve Preservation for Early Distal Gastric Cancer With Monitoring and Indocyanine Green Labeling

作者：Zhibo Yan, Wei Meng, Tongchao Zhang, Jinghao Guo, Ao Yu, Yize Liang, Yadi Huang, Xiaohan Cui, Honglei Wang, K Zhou, Zikun Dong, Wenbin Yu · 发表于：JAMA Surgery · 年份：2024 · DOI：10.1001/jamasurg.2024.5077 · 被引用次数：15 · 研究领域：Gastric Cancer Management and Outcomes、Cancer, Stress, Anesthesia, and Immune Response、Enhanced Recovery After Surgery

Importance: Radical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects. Objective: To assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer. Design, Setting, and Participants: This open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024. Interventions: Eligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG). Main Outcomes and Measures: The primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-tre...