Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2017; 23(39): 7129-7138
Published online Oct 21, 2017. doi: 10.3748/wjg.v23.i39.7129
Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life
Ze-Ning Huang, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ju-Li Lin
Ze-Ning Huang, Chang-Ming Huang, Chao-Hui Zheng, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Jian-Xian Lin, Jun Lu, Qi-Yue Chen, Long-Long Cao, Mi Lin, Ru-Hong Tu, Ju-Li Lin, Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
Author contributions: Huang ZN and Huang CM conceived the study, analyzed the data, drafted the manuscript, and made the video; Zheng CH, Li P, Xie JW and Wang JB helped revise the manuscript critically for important intellectual content; Lin JX, Lu J, Chen QY, Cao LL, Lin M, Tu RH and Lin JL helped collect the data and design the study; all authors read and approved the final manuscript.
Supported by National Key Clinical Specialty Discipline Construction program of China, No. [2012]649; and Key Project of Science and Technology Plan of Fujian Province, No. 2014Y0025.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Fujian Medical University Union Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Chang-Ming Huang, Professor, Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29, Xinquan Road, Fuzhou 350001, Fujian Province, China. hcmlr2002@163.com
Telephone: +86-591-83363366 Fax: +86-591-83320319.
Received: December 9, 2016
Peer-review started: December 9, 2016
First decision: January 10, 2017
Revised: March 22, 2017
Accepted: May 4, 2017
Article in press: May 4, 2017
Published online: October 21, 2017
Processing time: 316 Days and 8.7 Hours
Abstract
AIM

To evaluate the short-term outcomes and quality of life (QoL) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG).

METHODS

A total of 507 patients who underwent laparoscopic gastrectomy (D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG (group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy (LATG) (group A, n = 456). The short-term outcomes and QoL were compared between the two groups after 1:2 propensity-score matching (PSM). We used a questionnaire to assess QoL.

RESULTS

Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups (P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A (P < 0.05). After matching, group T reported better QoL in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better QoL (“Have you felt pain” and “Have you had difficulty eating solid food”) (P < 0.05).

CONCLUSION

The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving QoL after laparoscopic gastrectomy.

Keywords: Esophagojejunostomy; Overlap; Later-cut; Totally laparoscopic total gastrectomy; Quality of life

Core tip: This paper used propensity score-matched analysis and questionnaire survey to evaluate the short-term outcomes and quality of life (QoL) in patients who underwent digestive tract reconstruction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG) and in patients who underwent Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy. We found the IJOM for digestive reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving the QoL after laparoscopic gastrectomy.