Gastric cancer has an important place in the worldwide incidence of cancer and cancer-related deaths. It can metastasize to the lymph nodes in the early stages, and lymph node metastasis is an important prognostic factor. Surgery is a very important part of gastric cancer treatment. A D2 lymphadenectomy is the standard surgical treatment for cT1N+ and T2-T4 cancers, which are potentially curable. Recently, the TNM classification system was reorganized, and the margins for gastrectomy and lymphadenectomy were revised. Endoscopic, laparoscopic and robotic treatments of gastric cancer have progressed rapidly with development of surgical instruments and techniques, especially in Eastern countries. Different endoscopic resection techniques have been identified, and these can be divided into two main categories: endoscopic mucosal resection and endoscopic submucosal dissection. Minimally invasive surgery has been reported to be safe and effective for early gastric cancer, and it can be successfully applied to advanced gastric cancer with increasing experience. Cytoreductive surgery and hyperthermıc intraperıtoneal chemotherapy were developed as a combined treatment modality from the results of experimental and clinical studies. Also, hyperthermia increases the antitumor activity and penetration of chemotherapeutics. Trastuzumab which is a monoclonal antibody interacts with human epidermal growth factor (HER) 2 and is related to gastric carcinoma. The anti-tumor mechanism of trastuzumab is not clearly known, but mechanisms such as interruption of the HER2-mediated cell signaling pathways and cell cycle progression have been reported previously. H. pylori is involved in 90% of all gastric malignancies and Japanese guidelines strongly recommend that all H. pylori infections should be eradicated regardless of the associated disease. In this review, we present innovations discussed in recent studies.

Background: This study aimed to propose treatment strategies for high-output chylous ascites (CA) developed after gastric cancer surgery. Methods: The data of patients with CA after gastric cancer surgery in three high volume Training and Research Hospitals between 2005 and 2015 were retrospectively evaluated. Results: Nine patients out of 436 gastrectomies were detected with CA. The mean amount of daily fistula output was 939 mL. Treatment consisted of cessation of oral feeding, total parenteral nutrition (TPN), somatostatin analogs administration, clamping and/or removal of the drainage tube, diuretic administration and diet therapy with medium-chain triglycerides (MCTs) alone or in combination. The mean fistula closure time and length of hospital stay were 23 and 24 days respectively. Hemopneumothorax developed during right subclavian vein catheterisation for TPN implementation in one patient. There was no mortality. Conclusions: Combined cessation of oral feeding and TPN are usually used for treatment of CA as first-line treatment. However, TPN is no harmless. Although our data are limited they do allow us to conclude that diet with MCT’s may use for medical treatment of CA as first-line.

Peritoneal invasion is more common and has a worse prognosis in gastric cancer than most of other intestinal cancers. Advanced gastric cancers have a poor course in terms of the development of peritoneal carcinomatosis and prognosis, even if the curative resection has been performed. Patients usually die within the first 2 years of the postoperative period mainly due to peritoneal metastasis. It is, therefore, essential to eradicate intraperitoneal free cancer cells to prevent peritoneal recurrences. A standard therapy has not been developed yet for patients with gastric cancer with a positive peritoneal cytology or a gross peritoneal metastasis. Curative resection following neoadjuvant chemotherapy, postoperative oral S-1 chemotherapy, intraoperative intraperitoneal chemotherapy (IPC), and extensive intraoperative peritoneal lavage (EIPL)-IPC are recommended as therapeutic approaches. Although there is a limited number of studies on EIPL, which is a promising and exciting method in this patient population, unexpected results of survival have been demonstrated. We consider that the results of ongoing and further studies would lead to an extensive use of EIPL, which is a simple and easy method which can be applied anywhere and anytime, in patients with advanced gastic cancer and/or peritoneal cytology positive but peritoneal metastasis negative (CY+/P0) gastric cancer.

Aim: While laparoscopic appendectomy is the gold standard in the treatment of acute appendicitis, there is no consensus on reliable closure of the appendix stump. The aim of this study was to examine appendiceal stump closure techniques and their reliability during laparoscopic appendectomy. Material and Methods: Between January 2019 and August 2021, 692 patients who underwent laparoscopic appendectomy with the diagnosis of acute appendicitis were included in the study. Demographic characteristics, length of hospital stay, pathology, appendix stump closure methods, operation time, complications, and cost results were analyzed retrospectively. Results: Intracorporeal knotting (ICK) was used in 66.9% (n=463), and endoclip (EC) was used in 33.1% (n=229) of the patients. There was no statistically significant difference between the two groups in terms of length of hospital stay (p=0.054). While the mean operative time was 55.1±15.6 minutes in the ICK group, it was 45.7±16.5 minutes in the EC group (p<0.001). The general complication rate was 1.7% (n=12). While the complication rate was 2.2% (n=10) in ICK group, it was 0.9% (n=2) in EC group (p=0.354). While pericecal hematoma and ileus were seen only in the ICK group, the fistula was seen only in the EC group. EC was found to be more costly than ICK (p<0.001). Conclusion: It was concluded that closure of the appendix stump with an EC in patients who underwent laparoscopic appendectomy is more useful, regardless of the severity of appendicitis, with a shorter operation time and shorter length of hospital stay, low complication rate, and ease of application.