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Song T, Liu M, Xu K, Xing J, Guo K, Qi X, Gao P, Tan F, Yao Z, Zhang N, Yang H, Zhang C, Cui M, Su X. Comparison of the safety of esophagojejunal overlap and π-shaped anastomosis in totally laparoscopic total gastrectomy. BMC Surg 2025; 25:24. [PMID: 39810152 PMCID: PMC11730524 DOI: 10.1186/s12893-024-02703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 12/06/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND Globally, totally laparoscopic total gastrectomy is increasingly being accepted by surgeons for the treatment of gastric cancer. Overlap anastomosis and π-shaped anastomosis are the two most commonly used anastomosis methods in total laparoscopic surgery; however, their safety and suitability for the population are still unclear. METHODS A total of 162 consecutive patients with gastric cancer who underwent total laparoscopic total gastrectomy with overlap or π-shaped anastomosis were retrospectively analyzed. The intraoperative conditions and postoperative complications were compared. RESULTS A significant difference in the tumor location was found between the two groups (p < 0.05). No significant difference was found in the operation time, intraoperative blood loss, and postoperative hospital stay between the two anastomosis methods (p > 0.05); however, the π-shaped anastomosis group had more postoperative anastomotic leakage (p < 0.05). CONCLUSIONS Overlap anastomosis is recommended as the preferred anastomosis for totally laparoscopic total gastrectomy, and π-shaped anastomosis can be applied to non-gastroesophageal junction cancer with lower tumor location.
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Affiliation(s)
- Tongkun Song
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Maoxing Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Kai Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Jiadi Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Kechen Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Xinyu Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Pin Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Fei Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zhendan Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Nan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Chenghai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Ming Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Xiangqian Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, No.52 Fucheng Road, Haidian District, Beijing, 100142, China.
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Wang J, Liu S, Chen H, Luo J, Xu G, Feng X, Yang X, Yang J, Gang J. Final results of a randomized controlled trial: comparison of the efficacy and safety between totally laparoscopic and laparoscopic-assisted total gastrectomy for advanced Siewert III esophagogastric junction cancer and upper and middle third gastric cancer. Int J Surg 2025; 111:686-696. [PMID: 39185962 PMCID: PMC11745745 DOI: 10.1097/js9.0000000000002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/11/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND This study aimed to compare the efficacy and safety of TLTG with the overlap technique to LATG in patients with advanced Siewert III Esophagogastric Junction Cancer and upper and middle third gastric cancer. METHODS This single-center RCT enrolled 292 patients with the mentioned cancers, randomly assigned to TLTG overlap ( n =146) or LATG ( n =146) groups. Data on demographics, pathology, intraoperative variables, postoperative complications, recovery parameters, and 3-year survival were collected. Main outcome: postoperative complications within 30 days. Secondary outcomes: 3-year disease-free and overall survival. RESULTS TLTG versus LATG: TLTG had shorter incision, faster flatus/defecation, reduced analgesia, less opioid use, and shorter hospital stay. Similar operation time, anastomosis time, blood loss, and lymph node harvest. TLTG had a lower overall post-op complication rate (P=0.047) and no significant difference in serious complications ( P =0.310). Variances in anastomotic stenosis occurrence at 3 months. No rehospitalization or mortality at 30 days. No significant differences in 3-month disease-free survival ( P =0.058) or overall survival ( P =0.236). CONCLUSION The overlap method for anastomosis in TLTG is safe and feasible for advanced middle-upper-third gastric cancer, with positive short-term outcomes. This technique has the potential to be the preferred esophagojejunostomy approach in TLTG. TRIAL REGISTRATION This trial has been registered at Chinese Clinical Trial Registry: ChiCTR1900025667 (registration date: 4 September 2019).
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
- National Key Laboratory for Integrated Prevention and Treatment of Digestive System Tumors, Xi’an
| | - Shushang Liu
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Haixiang Chen
- Medical Record Department, Nanjing Hospital of C.M. Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Jialin Luo
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Guanghui Xu
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Xiangying Feng
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Xuewen Yang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Jianjun Yang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
- National Key Laboratory for Integrated Prevention and Treatment of Digestive System Tumors, Xi’an
| | - Ji Gang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
- National Key Laboratory for Integrated Prevention and Treatment of Digestive System Tumors, Xi’an
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Dieudonne M, Lv R, Xie W, Liu Q, Jiang J, Fu Y. Esophagojejunostomy using a circular stapler vs. a linear stapler for gastric cardia cancer patients: impact of upper margin length and tumor size on the survival rate. Front Surg 2024; 11:1385754. [PMID: 39444376 PMCID: PMC11496302 DOI: 10.3389/fsurg.2024.1385754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 08/26/2024] [Indexed: 10/25/2024] Open
Abstract
Background The incidence of gastric cancer is concomitantly rising with gastric cardia cancer worldwide. While the improvement of gastric cancer surgical techniques is glowing, this study assesses the impact of the upper margin length and tumor size on the survival rate for gastric cardia cancer patients who underwent total laparoscopic total gastrectomy(TLTG) or laparoscopic assisted total gastrectomy(LATG). Materials and methods A total of 63 patients with gastric cardia cancer who underwent laparoscopic total gastrectomy were retro-prospectively collected from January 2021 to May 2023. While assessing the impact of upper margin length and tumor size on the survival rate, esophagojejunostomy using a linear stapler has been compared to a circular stapler. Results The sixty-three patients met inclusion criteria; 32 (51%) underwent LATG and 31 (49%) underwent TLTG. Their mean age was 65 years (range, 45-77). The blood loss means in LATG and TLTG was 74.69 and 50.16 ml, respectively (p = 0.005), and surgery duration was higher in LATG than LATG with respective means of 247 min and 222.42 min. (p = 0.006). However, the tumor size means (p = 0.5), and upper margin length means (p = 0.052) were not significantly different in the LATG and TLTG groups, respectively. The number of resected and assessed lymph node was adequate in the LATG and TLTG groups. The current study still does not find an independent related risk from the upper margin length and tumor size to the survival rate according to the multiple regression analysis (p = 0.080). Conclusion The upper margin length and tumor size do not have a relationship with the survival rate of the compared esophagojejunostomy (EJS) methods. The EJS using a linear stapler requires a shorter surgery duration and less blood loss than EJS using a circular stapler.
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Affiliation(s)
- Maniragaba Dieudonne
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Gastrointestinal Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Renguang Lv
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Gastrointestinal Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wenjie Xie
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Gastrointestinal Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qi Liu
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Gastrointestinal Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jianwu Jiang
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Gastrointestinal Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yang Fu
- First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Gastrointestinal Surgery Department, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Wang ZQ, Liu YH, Cui WL, Ma MY, Wang J, Wang YP, Hua LC, Hong J, Hao HK. The safety and feasibility assessment of overlap esophagojejunostomy with self-pulling and latter transection technique in totally laparoscopic total gastrectomy. J Gastrointest Surg 2024; 28:1223-1228. [PMID: 38705366 DOI: 10.1016/j.gassur.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/08/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND This study presented an innovative technique in totally laparoscopic total gastrectomy (TLTG) for overlap esophagojejunostomy (E-J), termed self-pulling and latter transection (SPLT) (overlap SPLT). It evaluated the effectiveness and short-term outcomes of this novel method through a comparative analysis with the established functional end-to-end (FETE) E-J incorporating SPLT. METHODS From September 2018 to September 2023, this study enrolled 68 patients with gastric cancer who underwent TLTG with overlap SPLT anastomosis and 120 patients who underwent TLTG with FETE SPLT anastomosis. Clinicopathologic characteristics and surgical and postoperative outcomes data for overlap SPLT cases were gathered and retrospectively compared with those from FETE SPLT TLTG to evaluate the effectiveness and clinical safety. RESULTS The duration of anastomosis for overlap SPLT was 25.3 ± 7.4 minutes, significantly longer than that for the FETE SPLT (18.1 ± 4.0 minutes, P = .031). Perioperatively, 1 anastomosis-related complication occurred in each group, but this did not constitute a statistically significant difference (P = .682). No statistically significant differences were found between the 2 groups in terms of operative time, postoperative hospital stay, operative cost, surgical margins, or number of lymph nodes removed. Postoperative morbidity rates were similar between the groups (4.4% vs 5.8%, P = .676). CONCLUSION The overlap SPLT technique is regarded as a safe and feasible method for anastomosis. There were no apparent differences in complications between overlap SPLT and FETE SPLT, but overlap SPLT costed 1 additional stapler cartridge and required a longer duration.
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Affiliation(s)
- Ze-Qin Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Yan-Hong Liu
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Wen-Liang Cui
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Ming-Ye Ma
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Jian Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Ya-Ping Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Lu-Chun Hua
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Jun Hong
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China.
| | - Han-Kun Hao
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China.
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Ye Z, Yu P, Cao Y, Du Y. Catheter-guided anvil insertion for circular stapler esophagojejunal anastomosis: a novel technique in laparoscopic total gastrectomy. Updates Surg 2024; 76:1547-1552. [PMID: 38451410 PMCID: PMC11341632 DOI: 10.1007/s13304-024-01753-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE This study evaluates feasibility, safety, and short-term outcomes of employing the catheter-guided stapler anvil insertion technique for esophagojejunal anastomosis using a circular stapler during laparoscopic total gastrectomy (LTG). MATERIALS AND METHODS From September 2021 to April 2023, the catheter-guided stapler anvil insertion technique was employed in 80 patients undergoing laparoscopic total gastrectomy (LTG) for esophagojejunal anastomosis. A modified D2 dissection, according to the en bloc technique, was performed in the patients. Subsequently, a longitudinal incision, approximately 2 cm in length, was made on the anterior wall of the esophagus, about 2 cm above the tumor. The transection line was pre-marked with blue dye along the esophagus's minor axis, and the tail of the anvil was capped with a 10-cm length of catheter (F14 d4.7 mm). The surgeon secures the head of anvil and carefully inserts it into the esophagus, ensuring that only a 5-cm segment of the catheter remains outside the esophagus. A linear cutter was employed to transect and seal the lower end of the esophagus. Subsequently, esophagojejunostomy was performed under laparoscopic guidance using a circular stapler. RESULTS Among patients undergoing esophagojejunal anastomosis with the new technique, postoperative complications included pneumonia or pleural effusion in 14 patients (17.5%), anastomotic stenosis in 3 patients (3.75%), abdominal infection in 2 patients (2.5%), and intestinal obstruction in 1 patient (1.25%). No instances of anastomotic leakage, anastomotic bleeding, or deaths were recorded. All patients experiencing complications improved with conservative treatment, without the need for secondary surgery. CONCLUSION The catheter-guided stapler anvil insertion technique is demonstrated to be a safe and effective method for esophagojejunostomy, potentially reducing the occurrence of anastomotic leakage.
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Affiliation(s)
- Zeyao Ye
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Pengfei Yu
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Yang Cao
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China
| | - Yian Du
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, 310022, Zhejiang, China.
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Lin Z, Yan M, Lin Z, Xu Y, Zheng H, Peng Y, Li Y, Yang C. Short-term outcomes of distal gastrectomy versus total gastrectomy for gastric cancer under enhanced recovery after surgery: a propensity score-matched analysis. Sci Rep 2024; 14:17594. [PMID: 39080478 PMCID: PMC11289314 DOI: 10.1038/s41598-024-68787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/29/2024] [Indexed: 08/02/2024] Open
Abstract
Enhanced recovery after surgery (ERAS) has been used safely and effectively in patients with gastric cancer. Our aim was to evaluate the short-term outcomes of total gastrectomy (TG) versus distal gastrectomy (DG) for gastric cancer under ERAS. A prospectively collected database of 1349 patients with gastric cancer who underwent TG or DG between January 2016 and September 2022 was retrospectively analyzed. Propensity score matching analysis was used at a ratio of 1:1 to reduce confounding effects, and perioperative clinical outcomes were compared between the two groups. The primary outcome was overall postoperative complications (POCs). Secondary outcomes comprised time to bowel function recovery, postoperative hospital stay, mortality, and 30-day readmission rate. Of 1349 identified patients, 296 (21.9%) experienced overall POCs. Before matching, multivariable analysis revealed that age, body mass index, diabetes, operation time, and extent of gastrectomy were independent risk factors for overall POCs. After matching, each group comprised 495 patients, and no significant differences were observed between the groups for all parameters except tumor location. Compared with TG, DG was associated with significantly earlier days to first flatus and to eating a soft diet, and shorter postoperative hospital stay (P < 0.05). The incidence of overall- and severe POCs (Clavien-Dindo grade ≥ IIIa) in the TG group was significantly higher vs. the DG group (P < 0.05). There was no significant difference in the number of days to eating a liquid diet, or mortality and 30-day readmission rates between the groups (P > 0.05). In the subgroup analysis for middle-third gastric cancer, the TG group experienced higher rates of overall- and severe POCs, with a longer postoperative hospital stay. Compared with DG, patients who underwent TG had higher POC rates, slower recovery of bowel function, and longer duration of hospitalization under ERAS. Therefore, caution is needed when initiating early feeding for patients who undergo TG.
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Affiliation(s)
- Zhenmeng Lin
- Department of Anesthesiology Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Mingfang Yan
- Department of Anesthesiology Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Zhaoyan Lin
- College of Animal Science, Fujian Agriculture and Forestry University, Fuzhou, Fujian, China
| | - Yiping Xu
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Huizhe Zheng
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yunzhen Peng
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yangming Li
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China.
| | - Chunkang Yang
- Department of Gastrointestinal Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital, Fuzhou, Fujian, China.
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Saeki Y, Tanabe K, Ota H, Chikuie E, Takemoto Y, Karakuchi N, Kohata A, Miura O, Toyama E, Kugimiya N, Ohdan H. Exploratory study on the impact of intraesophageal pressure on quality of life in patients following total gastrectomy: a retrospective cohort study. BMC Surg 2024; 24:217. [PMID: 39068411 PMCID: PMC11282664 DOI: 10.1186/s12893-024-02504-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The usefulness of high-resolution impedance manometry (HRIM) in patients who underwent total gastrectomy with Roux-en-Y (R-Y) anastomosis has never been well validated. This study aimed to investigate whether intraesophageal pressure affects quality of life in patients who underwent total gastrectomy with R-Y anastomosis. METHODS The participants comprised 12 patients who underwent total gastrectomy for gastric cancer between October 2014 and July 2022 and underwent a postsurgical HRIM examination. The association between the HRIM data and Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaires was analyzed. RESULTS Esophageal body motility was normal in almost all patients. The anastomosis shape (circular stapler and overlap method with linear stapler) did not influence intraesophageal pressure. The integrated relaxation pressure and lower esophageal sphincter (LES) residual pressure during swallowing-induced relaxation were involved in "diarrhea subscale" scores (p = 0.0244 and p = 0.0244, respectively). The average maximum intrabolus pressure was not involved in postgastrectomy symptom. The contractile front velocity correlated with the "indigestion subscale," "diarrhea subscale," and "constipation subscale" (p = 0.0408, p = 0.0143, and p = 0.0060, respectively). The distal latency, i.e., the time from upper esophageal sphincter relaxation to contractile deceleration, was also associated with the "abdominal pain subscale" (p = 0.0399). LES pressure and esophageal body motility affected patients' quality of life after total gastrectomy. CONCLUSIONS HRIM for the evaluation of intraesophageal pressure is useful for the functional assessment of esophagojejunostomy with the R-Y reconstruction after total gastrectomy.
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Affiliation(s)
- Yoshihiro Saeki
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
- Division of Endoscopic Surgery, Hofu Institute of Gastroenterology, Hiroshima University Hospital, 14-33 Ekiminami-Machi, Hofu, Yamaguchi, 747-0801, Japan
| | - Kazuaki Tanabe
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
| | - Hiroshi Ota
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Emi Chikuie
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yuki Takemoto
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Nozomi Karakuchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Akihiro Kohata
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Osamu Miura
- Department of Gastroenterological Surgery, Hofu Institute of Gastroenterology, 14-33 Ekiminami-Machi, Yamaguchi, 747-0801, Japan
| | - Eiichiro Toyama
- Department of Gastroenterological Surgery, Hofu Institute of Gastroenterology, 14-33 Ekiminami-Machi, Yamaguchi, 747-0801, Japan
| | - Naruji Kugimiya
- Department of Gastroenterological Surgery, Hofu Institute of Gastroenterology, 14-33 Ekiminami-Machi, Yamaguchi, 747-0801, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Wu CY, Lin JA, Huang QZ, Xu JH, Zhong WJ, Kang WG, Wang JT, Chen JX, Zheng HD, Ye K. Comparison of short-term and long-term clinical effects of modified overlap anastomosis and conventional incision-assisted anastomosis in laparoscopic total gastrectomy. BMC Surg 2023; 23:306. [PMID: 37817168 PMCID: PMC10566090 DOI: 10.1186/s12893-023-02212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/01/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND To compare short-term and long-term clinical effects of modified overlap anastomosis and conventional incision-assisted anastomosis for laparoscopic total gastrectomy. METHODS This retrospective cohort study included patients with gastric cancer admitted to the Second Affiliated Hospital of Fujian Medical University from January 2016 to March 2020. Quality of life, intraoperative and postoperative conditions were analyzed. RESULTS Compared with the conventional assisted group, the modified overlap group showed a shorter auxiliary incision, milder postoperative pain, shorter time to the first postoperative anal exhaust, shorter time to the first postoperative liquid food intake, and shorter postoperative stay. There were no differences between the two groups regarding operation time, esophagus-jejunum anastomosis time, intraoperative blood loss, number of lymph nodes dissected, and length of the upper incision margin. There were no differences between the two groups regarding postoperative early and late complications. There were no differences between the two groups regarding the QLQ-C30 scale three years after the operation. The scores of the QLQ-STO22 scale 3 years after the operation showed significantly lower scores for dysphagia and feeding limit in the modified overlap group than those in the conventional assisted anastomosis group. There was no recurrence in the modified overlap group but one patient in the conventional assisted group. CONCLUSIONS Patients undergoing totally laparoscopic total gastrectomy with modified overlap anastomosis have better minimal invasiveness and faster post-operative recovery than conventional incision-assisted anastomosis.
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Affiliation(s)
- Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jian-An Lin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Qiao-Zhen Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Wen-Jin Zhong
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Wen-Gui Kang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jin-Tian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Jun-Xing Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, China.
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Lee SS. Endoscopic management of pseudo-lumen stapling following laparoscopic esophagojejunostomy: A case report. Int J Surg Case Rep 2023; 111:108830. [PMID: 37716056 PMCID: PMC10509695 DOI: 10.1016/j.ijscr.2023.108830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION Pseudo-lumen stapling can occur following an incidental submucosal introduction of a fork of the linear stapler into the esophageal side during esophagojejunostomy (EJS) after total gastrectomy. This leaves a mucosa-covered layer over the EJS site that can eventually cause an obstruction. If it is noticed intraoperatively, an immediate surgical take-down and repeat anastomosis might be chosen by most surgeons. However, these procedures might have side effects such as further dissection into the esophageal hiatus and unnecessary tension on the anastomosis. To our knowledge, no existing publication has presented a non-surgical management method for pseudo-lumen stapling. PRESENTATION OF CASE A 64-year-old male underwent laparoscopic total gastrectomy with a pseudo-lumen stapling unnoticed during surgery. Upon its recognition on the third postoperative day, endoscopic release of the tissue covering the anastomosis was performed. The procedure was successful. Gastrographic examination on the sixth postoperative day confirmed a good passage of the contrast agent. Postoperative one-year endoscopic examination confirmed patent anastomosis without stenosis. DISCUSSION Although pseudo-lumen stapling is one of the most unwanted consequences of EJS using linear staplers, there is little information or documentation available as reference for cases encountered during clinical practice. This might be related to the tendency of surgeons to perform an immediate take-down, followed by repeat EJS when this is noticed during surgery. We were able to successfully overcome this problem without surgery following a series of early gastrographic and endoscopic procedures. CONCLUSION Endoscopic release of the covering tissue should be considered a valid non-surgical solution to pseudo-lumen stapling.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea
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10
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Yan Y, Wang D, Mahuron K, Wang X, Lu L, Zhao Z, Melstrom L, Li C, Paz IB, Liu J, Fong Y, Li W, Fu W, Woo Y. Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers. Ann Surg Oncol 2023; 30:6718-6727. [PMID: 37442910 PMCID: PMC10506935 DOI: 10.1245/s10434-023-13771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/03/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial. We evaluated outcomes of minimally invasive esophagojejunostomy after laparoscopic or robotic total gastrectomies. METHODS We retrospectively reviewed MITG patients between 2015 and 2020 at two high-volume centers in China and the United States. Eligible patients were divided into groups by different reconstruction methods. We compared clinicopathologic characteristics, postoperative outcomes, including complication rates, overall survival rate (OS), disease-free survival rate (DFS), and patient-reported QoL. RESULTS GC patients (n = 105) were divided into intracorporeal esophagojejunostomy (IEJ, n = 60) and extracorporeal esophagojejunostomy (EEJ, n = 45) groups. EEJ had higher incidence of wound infection (8.3% vs 13.3%, P = 0.044) and pneumonia (21.7% vs 40.0%, P = 0.042) than IEJ. The linear stapler (LS) group was inferior to the circular stapler (CS) group in reflux [50.0 (11.1-77.8) vs 44.4 (0.0-66.7), P = 0.041] and diarrhea [33.3 (0.0-66.7) vs 0.0 (0.0-66.7), P = 0.045] while LS was better than CS for dysphagia [22.2 (0.0-33.3) vs 11.1 (0.0-33.3), P = 0.049] and eating restrictions [33.3 (16.7-58.3) vs 41.7 (16.7-66.7), P = 0.029] at 1 year. OS and DFS did not differ significantly between LS and CS. CONCLUSIONS IEJ anastomosis generated better results than EEJ. LS was associated with a better patient eating experience, but more diarrhea and reflux compared with CS. Clinical and patient-reported outcomes show the superiority of IEJ with the LS reconstruction method in MITG for GC.
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Affiliation(s)
- Yongjia Yan
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Daohan Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Kelly Mahuron
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Xi Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Lu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhicheng Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Laleh Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Chuan Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - I Benjamin Paz
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Jian Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Weidong Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
- Cancer Immunotherapeutics Program, Beckman Research Institute, City of Hope, Duarte, CA, USA.
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11
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Aiolfi A, Sozzi A, Bonitta G, Lombardo F, Cavalli M, Campanelli G, Bonavina L, Bona D. Short-term outcomes of different esophagojejunal anastomotic techniques during laparoscopic total gastrectomy: a network meta-analysis. Surg Endosc 2023:10.1007/s00464-023-10231-6. [PMID: 37400689 DOI: 10.1007/s00464-023-10231-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/17/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Different techniques have been described for esophagojejunostomy (EJ) during laparoscopic total gastrectomy (LTG) for gastric cancer. Linear stapled techniques include overlap (OL) and functional end-to-end anastomosis (FEEA) while single staple technique (SST), hemi-double staple technique (HDST), and OrVil® are circular stapled approaches. Nowadays, the choice among techniques for EJ depends on operating surgeon personal preference. PURPOSE To compare short-term outcomes of different EJ techniques during LTG. METHODS Systematic review and network meta-analysis. OL, FEEA, SST, HDST, and OrVil® were compared. Primary outcomes were anastomotic leak (AL) and stenosis (AS). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to measure relative inference. RESULTS Overall, 3177 patients (20 studies) were included. The technique for EJ was SST (n = 1026; 32.9%), OL (n = 826; 26.5%), FEEA (n = 752; 24.1%), OrVil® (n = 317; 10.1%), and HDST (n = 196; 6.4%). AL was comparable for OL vs. FEEA (RR = 0.82; 95% CrI 0.47-1.49), OL vs. SST (RR = 0.55; 95% CrI 0.27-1.21), OL vs. OrVil® (RR = 0.54; 95% CrI 0.32-1.22), and OL vs. HDST (RR = 0.65; 95% CrI 0.28-1.63). Similarly, AS was similar for OL vs. FEEA (RR = 0.46; 95% CrI 0.18-1.28), OL vs. SST (RR = 0.89; 95% CrI 0.39-2.15), OL vs. OrVil® (RR = 0.36; 95% CrI 0.14-1.02), and OL vs. HDST (RR = 0.61; 95% CrI 0.31-1.21). Anastomotic bleeding, time to soft diet resumption, pulmonary complications, hospital length of stay, and mortality were comparable while operative time was reduced for FEEA. CONCLUSIONS This network meta-analysis shows similar postoperative AL and AS risk when comparing OL, FEEA, SST, HDST, and OrVil® techniques. Similarly, no differences were found for anastomotic bleeding, operative time, soft diet resumption, pulmonary complications, hospital length of stay and 30-day mortality.
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Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy.
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Luigi Bonavina
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
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Chen D, Yang F, He F, Woraikat S, Tang C, Qian K. Effectiveness and safety of self-pulling and latter transected reconstruction in totally laparoscopic total gastrectomy: a comparison with laparoscopic-assisted total gastrectomy. BMC Surg 2023; 23:183. [PMID: 37386426 DOI: 10.1186/s12893-023-02077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND In some earlier studies, self-pulling and later transection (SPLT) esophagojejunostomy (E-J) was incorporated into total laparoscopic total gastrectomy (TLTG) procedures. Its effectiveness and safety, however, remain unknown. This study compared (SPLT)-E-J in TLTG with conventional E-J in laparoscopic-assisted total gastrectomy (LATG) in order to assess the short-term safety and efficacy of (SPLT)-E-J in TLTG. METHODS This research analyzed patients with gastric cancer who received SPLT-TLTG or LATG between January 2019 and December 2021 in the First Affiliated Hospital of Chongqing Medical University. Baseline data and postoperative short-term surgical outcomes were obtained retrospectively and compared between the two groups. RESULTS A total of 83 patients who underwent SPLT-TLTG (n = 40, 48.2%) or LATG (n = 43, 51.8%) were included in this study. There were no differences between the two groups in terms of patient demographics or tumor characteristics. No statistically significant differences were observed between the two groups in terms of operation time, intraoperative blood loss, harvested lymph nodes, postoperative complications, postoperative decrease in hemoglobin and albumin levels, or postoperative hospital stay. Five and seven patients experienced short-term postoperative complications in the SPLT-TLTG and LATG groups, respectively. CONCLUSIONS SPLT-TLTG is a dependable and safe surgical method for the treatment of gastric cancer. Its short-term outcomes were similar to those of conventional E-J in LATG and had advantages regarding surgical incision and simplification of reconstruction.
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Affiliation(s)
- Defei Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fuyu Yang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fan He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Saed Woraikat
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chenglin Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Yamauchi S, Kanda S, Yoshimoto Y, Kubota A, Tsuda K, Yube Y, Kaji S, Oka S, Orita H, Brock MV, Mine S, Fukunaga T. Double stapling technique versus hemi-double stapling technique for esophagojejunostomy with OrVil™ after laparoscopic total gastrectomy: a single-blind, randomized clinical trial. Surg Endosc 2023:10.1007/s00464-023-10068-z. [PMID: 37076615 DOI: 10.1007/s00464-023-10068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The transorally inserted anvil (OrVil™) is frequently selected for esophagojejunostomy after laparoscopic total gastrectomy (LTG) because of its versatility. During anastomosis with OrVil™, the double stapling technique (DST) or hemi-double stapling technique (HDST) can be selected by overlapping the linear stapler and the circular stapler. However, no studies have reported the differences between the methods and their clinical significance. METHODS A randomized controlled clinical trial with a parallel assignment and single-blind outcomes assessment analysis was conducted. Patients with gastric cancer eligible for LTG who met the selection criteria were randomized. Preoperative characteristics and perioperative and postoperative outcomes were compared between the DST and HDST. The primary endpoint was an anastomosis-related complication, and the secondary endpoints were perioperative outcomes and postoperative complications, excluding anastomosis-related complications. RESULTS Thirty patients with gastric cancer were eligible and randomized. LTG and esophagojejunostomy were successfully performed in all patients, without conversion to laparotomy. Preoperative characteristics, excluding preoperative chemotherapy, were not significantly different between the two groups. One anastomotic leakage of Clavien-Dindo classification grade ≥ IIIa was observed in the DST, although no significant difference was found between the two groups (6.6% vs. 0%, P = 0.30). In the HDST, one case of anastomotic stricture required endoscopic balloon dilation. No significant differences were found in operative time, whereas the anastomosis time was significantly shorter in the HDST than in the DST (47.5 ± 15.8 vs. 38.2 ± 8.8 min, P = 0.028). Except for anastomosis-related complications, postoperative complications (P = 0.282) and postoperative hospital stay for the DST and HDST were not significantly different. CONCLUSIONS No superiority was found between the DST and HDST with OrVil™ in esophagojejunostomy of LTG for gastric cancer with respect to postoperative complications, whereas the HDST may be preferable in terms of the simplicity of the surgical technique.
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Affiliation(s)
- Suguru Yamauchi
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Satoshi Kanda
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yutaro Yoshimoto
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Akira Kubota
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Kenki Tsuda
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Shinichi Oka
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hajime Orita
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Malcolm V Brock
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
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14
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Aslan M, Topgül K. A novel, easier and safer alternative method for oesophagojejunal reconstruction after totally laparoscopic total gastrectomy. Surg Endosc 2023; 37:4075-4083. [PMID: 36952045 DOI: 10.1007/s00464-023-09992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/25/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND This study presents a novel laparoscopic modified overlapping oesophagojejunostomy anastomosis method which consists of self-pulling and latter transection to perform a safer anastomosis, describes the anastomosis technique in detail and reveals its short-term outcomes. METHODS Forty-five patients underwent totally laparoscopic total gastrectomy using the self-pulling and oesophagus latter-cut overlap method anastomosis for gastric cancer from January 2019-2022. During the self-pulling phase, the oesophagus was ligated at the level of the gastroesophageal junction or above and dragged down by a ligature rope to mobilise up to 5-6 cm. An entry hole was created on the right side of the oesophagus, and a nasogastric tube was taken out through the hole and tip of the tube was used as a guide for the endoscopic linear stapler to decrease the risk of entering the false lumen and creating a side-to-side anastomosis. The oesophagus was then latter-transected by a second endoscopic linear stapler. The common entry hole was closed using a hand-sewing method. Clinicopathological characteristics and surgical outcomes were collected and retrospectively evaluated. RESULTS The mean anastomosis duration was 27 min. The morbidity rate was 4.4%. Only two patients experienced postoperative complications but subsequently recovered conservatively. None of the patients suffered anastomotic leak or stricture. CONCLUSIONS Self-pulling and latter transection-based overlapping anastomosis is a simple and reliable approach that overcomes most of the limitations of standard overlap method and provides satisfactory surgical outcomes.
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Affiliation(s)
- Mehmet Aslan
- Surgical Oncology Consultant, Department of Surgical Oncology, VM Medicalpark Hospital, Kocaeli, Turkey.
- , Tüysüzler Mahallesi, gülibrişim Sokak, No: 16/b1, Kıbrıs villaları 3. Etap 41100 İzmit, Kocaeli, Turkey.
| | - Koray Topgül
- Department of General Surgery, VM Medicalpark Hospital, Kocaeli, Turkey
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15
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Chen X, Lin T, Zhao M, Yang J, Huang H, Zhao L, Liu H, Chen T, Chen H, Hu Y, Li G, Yu J. Safety and Efficacy of OGT-Assisted Overlap Oesophagojejunostomy Versus the Traditional Overlap Method in Laparoscopic Total Gastrectomy for Gastric/Gastroesophageal Junction (G/GEJ) Tumours. Ann Surg Oncol 2023; 30:2729-2738. [PMID: 36658250 DOI: 10.1245/s10434-022-13031-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/13/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Overlap guiding tube (OGT)-assisted overlap oesophagojejunostomy (EJS), which was first designed and reported by our team, has shown feasibility. However, its safety and efficiency have not yet been compared with the conventional overlap approach. METHODS We retrospectively analysed the data of 155 gastric/gastroesophageal junction (G/GEJ) cancer patients who underwent laparoscopic total gastrectomy by conventional (conventional group, n = 83) or OGT-assisted (OGT group, n = 72) overlap methods at Nanfang Hospital. The anastomotic efficiency and surgical outcomes were compared between the two groups. RESULTS The success rate of inserting an anvil fork into the oesophageal lumen at the first attempt in the OGT group was much higher than in the conventional group (86.7% vs. 97.2%, P = 0.019). Consistently, the duration of EJS (P < 0.001) in the OGT group was significantly shorter than that in the conventional group. Operatively, there was one case in which oesophageal pseudocanals developed; another case was converted to thoracoscopic surgery in the conventional group, but there were no such cases in the OGT group. In terms of postoperative recovery, the OGT group was superior to the conventional group. The incidence of postoperative complications (28.9% vs. 20.8%, P = 0.247) and the classification of complication severity (P = 0.450) were milder in the OGT group, although the difference was not statistically significant. Notably, the conventional group had four cases (4.8%) of oesophagojejunal anastomotic leakage (EJAL) and one case (1.2%) of anastomotic stenosis. In the OGT group, two patients (2.8%) developed EJAL, but none developed anastomotic stenosis or anastomotic bleeding. Neither group had any cases of unplanned secondary surgery or perioperative deaths. CONCLUSIONS The OGT-assisted method reduced the surgical difficulty of overlap EJS with good safety. This study provides new perspectives for optimizing EJS.
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Affiliation(s)
- Xinhua Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tian Lin
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Mingli Zhao
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jia Yang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Huilin Huang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liying Zhao
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tao Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hao Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Guoxin Li
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Jiang Yu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Yin JH, Chen YH, Ren YB, Wang R, Su S, Jiang EL, Li YB, Wang T, Xiao WD, Du GS. Feasibility and preliminary experience of single-incision plus one-port laparoscopic total gastrectomy with Overlap esophagojejunostomy for gastric cancer: A study of 10 cases. Front Surg 2023; 9:1071363. [PMID: 36700036 PMCID: PMC9869672 DOI: 10.3389/fsurg.2022.1071363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to explore the feasibility and safety of single-incision plus one-port laparoscopic total gastrectomy (SITG + 1) with Overlap esophagojejunostomy (SITG + 1-Overlap) and to share preliminary experiences. Methods This retrospective study included 10 patients with gastric cancer located in the cardia or body who underwent SITG + 1-Overlap between August 2020 and October 2021.The demographics, tumor characteristics, postoperative outcomes, and short-term complications of all the enrolled patients were summarized and statistically analyzed. Data were expressed as mean ± standard deviation (SD) if they were normally distributed. Otherwise, Median (Quartile1, Quartile3) was used. Results In the collective perioperative data of these 10 patients who underwent radical gastrectomy, the median of the length of transumbilical incision and blood loss were 3.0 cm and 100.0 ml respectively, and the mean operation time and 385.5 ± 51.6 min. Postoperative data indicated that the gastric tube was removed on 2.0 (2.0, 3.0) days, and the timing of first feeding, activity, flatus, and defecation was 1.5 (1.0, 2.0) days, 2.0 (2.0, 2.0) days, 3.0 (2.0, 3.0) days, and 3.8 ± 0.6 days, respectively. The timing of drainage tube removal was 4.6 ± 1.0 days after operation. The duration of hospital stay was 7.5 ± 1.2 days and the VAS pain scores for the 3 days following surgery were 3.0 (2.0, 3.3), 2.0 (2.0, 3.0), and 1.5 (1.0, 2.0) respectively. The mean number of retrieved lymph nodes was 30.7 ± 13.2. Most biochemical indicators gradually normalized with the recovery of the patients after surgery. No 30-day postoperative complications were noted. Conclusions For the first time, our preliminary data indicate the feasibility and safety of Overlap esophagojejunostomy in SITG + 1 surgery. This modified Overlap procedure has the potential to simplify the reconstruction procedure and lower the technical challenge of SITG + 1 radical gastrectomy for cardia or upper gastric cancer in the early and advanced stages.
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Affiliation(s)
- Jiu-Heng Yin
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi-Hui Chen
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan-Bei Ren
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Rong Wang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shuai Su
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - En-Lai Jiang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yun-Bo Li
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ting Wang
- Nursing Department, Nursing School of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Wei-Dong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China,Correspondence: Wei-Dong Xiao Guang-Sheng Du
| | - Guang-Sheng Du
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China,Correspondence: Wei-Dong Xiao Guang-Sheng Du
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17
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Noshiro H, Okuyama K, Yoda Y. Disturbed passage of jejunal limb near esophageal hiatus after overlapped esophagojejunostomy following laparoscopic total gastrectomy. World J Gastrointest Surg 2022; 14:1285-1296. [PMID: 36504516 PMCID: PMC9727568 DOI: 10.4240/wjgs.v14.i11.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/16/2022] [Accepted: 10/31/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Overlapped esophagojejunostomy (OEJ) is a secure purely laparoscopic reconstruction after laparoscopic total gastrectomy (LTG). However, long-term surgical results have not been documented well.
AIM In this paper, we report unusual patients who manifested jejunal limb stricture near the esophageal hiatus without anastomotic stenosis during long-term observation after surgery.
METHODS From April 2009 until May 2020, we retrospectively reviewed 211 patients underwent LTG following by OEJ for gastric carcinoma and took a standard surveillance program. We aimed to characterize a novel complicated disorder observed in these patients to assist treatment and prevention.
RESULTS Five patients (2.4%) had unusual jejunal limb stricture after LTG and OEJ, occurring at a mean of 10 mo after initial radical LTG. All five patients had disturbed oral intake and marked weight loss, and two had aspiration pneumonia. Various diagnostic modalities and intraoperative findings in each patient revealed an intact anastomosis, bent or tortuous jejunal limb resulting from loose fibrous adhesions on the left crus at the esophageal hiatus and no cancer recurrence. All five patients were successfully treated by reoperation for adhesiolysis, division of the left crus and rearrangement of the jejunal limb.
CONCLUSION Disturbed passage through the jejunal limb near the hiatus can occur after some types of OEJ following LTG. We speculate that it may result from a short remnant esophagus, excessive mobilization of the jejunal limb that permits bending or tortuosity and adhesions on the left crus at the hiatus. Prevention for this complication is possible during the original LTG procedure.
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Affiliation(s)
- Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan
| | | | - Yukie Yoda
- Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan
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18
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Bracale U, Peltrini R, De Luca M, Ilardi M, Di Nuzzo MM, Sartori A, Sodo M, Danzi M, Corcione F, De Werra C. Predictive Factors for Anastomotic Leakage after Laparoscopic and Open Total Gastrectomy: A Systematic Review. J Clin Med 2022; 11:5022. [PMID: 36078954 PMCID: PMC9457286 DOI: 10.3390/jcm11175022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this systematic review is to identify patient-related, perioperative and technical risk factors for esophago-jejunal anastomotic leakage (EJAL) in patients undergoing total gastrectomy for gastric cancer (GC). A comprehensive literature search of PubMed/MEDLINE, Embase and Scopus databases was performed. Studies providing factors predictive of EJAL by uni- and multivariate analysis or an estimate of association between EJAL and related risk factors were included. All studies were assessed for methodological quality, and a narrative synthesis of the results was performed. A total of 16 studies were included in the systematic review, with a total of 42,489 patients who underwent gastrectomy with esophago-jejunal anastomosis. Age, BMI, impaired respiratory function, prognostic nutritional index (PNI), alcohol consumption, chronic renal failure, diabetes and mixed-type histology were identified as patient-related risk factors for EJAL at multivariate analysis. Likewise, among operative factors, laparoscopic approach, anastomosis type, additional organ resection, blood loss, intraoperative time and surgeon experience were found to be predictive factors for the development of EJAL. In clinical setting, we are able to identify several risk factors for EJAL. This can improve the recognition of higher-risk patients and their outcomes.
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Affiliation(s)
- Umberto Bracale
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
| | - Roberto Peltrini
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Marcello De Luca
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Mariangela Ilardi
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | | | - Alberto Sartori
- Department of Surgery, San Valentino Montebelluna Hospital, 31044 Treviso, Italy
| | - Maurizio Sodo
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Michele Danzi
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Francesco Corcione
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy
| | - Carlo De Werra
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy
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19
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Xing J, Xu K, Liu M, Gao P, Tan F, Yao Z, Zhang N, Yang H, Zhang C, Cui M, Su X. Modified π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy: a report of 40 consecutive cases from a single center. J Int Med Res 2022; 50:3000605221116328. [PMID: 35983668 PMCID: PMC9393679 DOI: 10.1177/03000605221116328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Intracorporeal esophagojejunostomy remains a challenging technique in totally
laparoscopic total gastrectomy (TLTG) because of the lack of an established
standard anastomosis method. However, π-shaped esophagojejunostomy in TLTG
is reportedly safe and feasible. Therefore, we evaluated the short-term
surgical outcomes of our modified π-shaped esophagojejunostomy in TLTG. Methods This study involved patients without neoadjuvant therapy diagnosed with
gastric cancer who underwent TLTG by the same surgeon with modified π-shaped
esophagojejunostomy from April 2018 to October 2019. Clinicopathologic data
were collected and retrospectively analyzed. Results Forty patients diagnosed with gastric cancer were included. The mean
operative time and estimated blood loss were 264.6 ± 56.9 minutes and
68.5 ± 53.3 mL, respectively. Postoperative flatus occurred at 4.6 ± 1.7
days. The mean time to resumption of diet was 7.4 ± 1.7 days
postoperatively. One patient was diagnosed with anastomotic leakage and
managed with conservative therapy. Pleural effusion was the most common
complication, occurring in four (10%) patients. One patient developed
intra-abdominal bleeding that required reoperation. Other complications were
atrial fibrillation and wound infection. No mortality occurred during the
6-month follow-up. Conclusions Modified π-shaped esophagojejunostomy is safe and feasible for intracorporeal
anastomosis in TLTG and showed favorable surgical outcomes in this
study.
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Affiliation(s)
- Jiadi Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kai Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Maoxing Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Pin Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhendan Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Nan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chenghai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ming Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangqian Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
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20
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Guo Z, Deng C, Zhang Z, Liu Y, Qi H, Li X. Safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer: A systematic review and meta-analysis. Int J Surg 2022; 102:106684. [DOI: 10.1016/j.ijsu.2022.106684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/30/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023]
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21
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Sun D, Zhang R, Wei M, Liu P, Zhong X, Liang Y, Chen Y, Huang Y, Yu W. Comparison Between Linear Stapler and Circular Stapler After Laparoscopic-Assisted Distal Gastrectomy in Patients With Gastric Cancer. Front Surg 2022; 9:858236. [PMID: 35599787 PMCID: PMC9120601 DOI: 10.3389/fsurg.2022.858236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimTo evaluate the safety and efficacy of laparoscopy distal gastrectomy using a linear stapler compared with a circular stapler in patients with gastric cancer.MethodsWe retrospectively reviewed 173 patients who underwent laparoscopic distal gastrectomy for gastric cancer at a single center from January 2018 to December 2020. Patients were categorized into the linear stapler group and the circular stapler group. General data, intraoperative and postoperative outcomes, postoperative pathological results, postoperative complications, and postoperative follow-up in the two groups were compared and analyzed.ResultsThe operation time (208.76 ± 32.92 vs. 226.69 ± 26.92 min, p < 0.05), anastomosis time (71.87 ± 9.50 vs. 90.56 ± 3.18 min, p < 0.05), time to first flatus (68.60 ± 25.96 vs. 76.16 ± 21.05 h, p < 0.05), time to the first sip of water (3.66 ± 0.61 vs. 4.07 ± 0.77 days, p < 0.05), and time to the first liquid diet (4.43 ± 1.02 vs. 5.03 ± 1.70 days, p < 0.05) were significantly shorter in the linear stapler group. In addition, the highest postoperative body temperature within 3 days (37.4 ± 0.61 vs. 37.7 ± 0.61, p < 0.05) after the operation, white blood cell count (WBC) on the 3rd day (9.07 ± 2.52 vs. 10.01 ± 2.98 × 10∧9/L, p < 0.05), and average gastric tube drainage within 3 days (36.65 ± 24.57 vs. 52.61 ± 37 ml, p < 0.05) were also significantly lower in the linear stapler group.ConclusionsBoth circular and linear staplers are safe and feasible for gastrointestinal reconstruction in laparoscopic distal gastrectomy. In contrast, a linear stapler has advantages over a circular stapler in shortening operation time and accelerating the postoperative recovery of patients.
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Affiliation(s)
- Danping Sun
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Renhua Zhang
- Outpatient Department, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Meng Wei
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peng Liu
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xin Zhong
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yize Liang
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuanyuan Chen
- Department of Nursing Department, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yadi Huang
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wenbin Yu
- Department of Gastrointestinal Surgery, General Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
- *Correspondence: Wenbin Yu
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22
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Jin T, Liu HD, Chen ZH, Hu JK, Yang K. Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis. J INVEST SURG 2022; 35:1434-1444. [PMID: 35435081 DOI: 10.1080/08941939.2022.2058126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tao Jin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han-Dong Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
| | - Ze-Hua Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
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23
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Chen C, Wei M, Feng X, Han H, Wang C, He Q, Yu W. Comparison of reverse puncture device and overlap in laparoscopic total gastrectomy for gastric cancer. J Minim Access Surg 2022; 18:31-37. [PMID: 33047683 PMCID: PMC8830560 DOI: 10.4103/jmas.jmas_276_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Intracorporeal oesophagojejunostomy is one of the key steps in laparoscopic total gastrectomy (LTG). At present, there is no widely accepted anastomosis technique in oesophagojejunostomy. MATERIALS AND METHODS We retrospectively studied 63 patients with gastric cancer who underwent LTG. Two types of anastomosis techniques have been applied during LTG: the reverse puncture device (RPD) (28 patients) and overlap (35 patients). RESULTS A total of 63 patients (51 males and 12 females: mean age = 58 years and mean body mass index [BMI] = 26.3 kg/m2) were enrolled in this study. There were no significant difference in age, BMI, duration of surgery, duration of anastomosis, blood loss, post-operative hospital stay, tumour location, tumour size, degree of tumour differentiation, Borrmann type, total number of lymph nodes, number of positive lymph nodes, hospital stay, hospitalisation costs, intra-operative complications, post-operative complications and prognosis between the RPD group and the overlap group. RPD group showed a significant advantage in terms of the distance between the top border of tumours and the top resection margin (P < 0.001). We further found that the oesophageal lateral negative surgical margin distance of the upper gastric cancer in the RPD group was significantly longer than that in the overlap group (P < 0.001). CONCLUSIONS Both the RPD and overlap techniques are safe and applicable in LTG. However, RPD has the advantage of obtaining an adequate safe margin compared with that of overlap technique, especially in patients with gastro-oesophageal junction carcinoma.
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Affiliation(s)
- Cheng Chen
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Meng Wei
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xingbo Feng
- Department of General Surgery, Central Hospital of Zaozhuang Coal Mining Group, Shandong Province, Zaozhuang, China
| | - Haifeng Han
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chao Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Wenbin Yu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
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24
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Application value of overlap guiding tube (OGT) in assisting overlap esophagojejunostomy during laparoscopic total gastrectomy for gastric/gastroesophageal junction (G/GEJ) tumors. Gastric Cancer 2022; 25:827-836. [PMID: 35460378 PMCID: PMC9225966 DOI: 10.1007/s10120-022-01296-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The overlap guiding tube (OGT) method, which was designed by our team to assist in overlap esophagojejunostomy, could potentially provide new perspectives for esophagojejunostomy. The application of the OGT-assisted method was first explored by our team and has not yet been reported. METHODS This cohort study analyzed the 3 month outcomes of 38 gastric/gastroesophageal junction (G/GEJ) tumor patients who underwent OGT-assisted overlap esophagojejunostomy. RESULTS There were 27 males and 11 females, aged 40-82 years. All patients underwent surgery successfully. The success rate of inserting anvil fork into esophageal lumen at first attempt was 97.4%. The total operation time, esophagojejunostomy time, volume of intraoperative blood loss, and length of surgical incision were 317.6 ± 51.5 min, 20.8 ± 3.8 min, 50.0 (range 15.0-200.0) ml, and 5.0 (range 4.0-8.0) cm, respectively. No procedures were converted to other laparoscopic anastomosis techniques or open approaches. The time to postoperative initial flatus, liquid diet intake, soft diet intake, and length of postoperative hospital stay were 3.0 (range 1.0-6.0) days, 4.0 (range 2.0-9.0)days, 6.0 (range 3.0-11.0) days, and 8.5 (range 6.0-16.0) days, respectively. Overall, postoperative complications were observed in 8 (21.1%) patients. Among them, one patients developed esophagojejunal anastomotic leakage. After 3 months of follow-up, none of the patients developed anastomotic stenosis or experienced unplanned secondary surgery or perioperative death. CONCLUSIONS OGT-assisted overlap esophagojejunostomy for patients with G/GEJ tumors is safe and feasible, with good short-term effects. OGT method has a satisfactory success rate of inserting anvil fork into esophageal lumen at first attempt and could prevent from developing esophageal submucosa pseudocanals.
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25
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Fujimoto D, Taniguchi K, Miura F, Kobayashi H. Alimentary tract obstruction attributed to use of barbed suture for double tract reconstruction after robot-assisted proximal gastrectomy: a case report. BMC Surg 2021; 21:406. [PMID: 34844585 PMCID: PMC8630912 DOI: 10.1186/s12893-021-01407-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Anastomotic stenosis following esophagojejunostomy reconstruction by the overlap method with absorbable barbed sutures occurs only rarely in patients who have undergone laparoscopic surgery. We report anastomotic stenosis by the overlap method that we attributed to the lack of tactile sensation during robot-assisted surgery. Case presentation An 83-year-old man underwent robot-assisted laparoscopic proximal gastrectomy and lymph node dissection at our hospital for treatment of gastric cancer. Double tract reconstruction followed with side-to-side esophagojejunostomy (overlap method) performed with an endoscopic linear stapler. On completion of the anastomosis, the enterotomy was closed under robotic assistance with absorbable barbed suture. Once solid foods were introduced, the patient had difficulty swallowing and felt as though his digestive tract was stopped up. When upper gastrointestinal endoscopy was performed, we found the anastomotic lumen to be coated with food residue. After rinsing off the residue with water, we could see barbed suture protruding into the anastomotic lumen that had become entangled upon itself, which explained how the food residue had accumulated. We cut the entangled suture under endoscopic visualization using a loop cutter. Conclusion This case highlights a stricture caused by insufficiently tensioning barbed suture, which subsequently protruded into the anastomotic lumen and became entangled upon itself. We believe this occurrence was associated with the lack of tactile sensation in robot-assisted surgery.
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Affiliation(s)
- Daisuke Fujimoto
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan.
| | - Keizo Taniguchi
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan
| | - Fumihiko Miura
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Hospital Mizunokuchi, 5-1-1 Futako, Takatsu-ku, Kawasaki City, Kanagawa, 213-8507, Japan
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Foley DM, Emanuwa EJE, Knight WRC, Baker CR, Kelly M, McEwan R, Zylstra J, Davies AR, Gossage JA. Analysis of outcomes of a transoral circular stapled anastomosis following major upper gastrointestinal cancer resection. Dis Esophagus 2021; 34:6130170. [PMID: 33554244 DOI: 10.1093/dote/doab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Esophageal anastomoses performed following esophagectomy and total gastrectomy are technically challenging with a significant risk of anastomotic leak. A safe, reliable, and easy anastomotic technique is required to improve patient outcomes and reduce morbidity. METHOD This paper analyses 328 consecutive patients who underwent transoral circular stapled esophageal anastomosis (ORVIL™) from a prospectively collected single-center database between December 2011 and February 2019. RESULTS Two hundred and twenty-seven esophagectomies and 101 gastrectomies were performed using OrVil™ anastomoses. The mean patient age was 63.7 years. Of 328 consecutive OrVil™-based anastomoses, there were 10 clinically significant anastomotic leaks requiring radiological or operative intervention (3.05%). Twenty-eight (8.54%) patients developed anastomotic stricture, all of which were successfully treated with endoscopic balloon dilatation (a median of 1 dilatation was required per patient). CONCLUSION The OrVil™ anastomotic technique is reliable and safe to perform. This is the largest reported series of the OrVil™ anastomotic technique to date. Leak rates and anastomotic dilations were similar to other reported series. Based on our experience, we consider the use of the OrVil™ device for reconstruction after major upper GI resection to be safe and reliable.
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Affiliation(s)
- Daniel M Foley
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - William R C Knight
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Cara R Baker
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Kelly
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ricardo McEwan
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Janine Zylstra
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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27
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Milone M, Elmore U, Manigrasso M, Vertaldi S, Aprea G, Servillo G, Parise P, De Palma GD, Rosati R. Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis. Am J Surg 2021; 223:884-892. [PMID: 34627600 DOI: 10.1016/j.amjsurg.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/24/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy. METHODS A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients' number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results. RESULTS 12 articles were included in the final analysis. A significant difference was observed in terms of "overall anastomotic complications" in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies. CONCLUSION Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sara Vertaldi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
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A Multicenter Retrospective Study Comparing Surgical Outcomes Between the Overlap Method and Functional Method for Esophagojejunostomy in Laparoscopic Total Gastrectomy: Analysis Using Propensity Score Matching. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:89-95. [PMID: 34545031 DOI: 10.1097/sle.0000000000001008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to compare the postoperative outcomes after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using the overlap method or the functional method in a multicenter retrospective study with propensity score matching. METHODS We retrospectively enrolled all patients who underwent curative LTG for gastric cancer at 6 institutions between January 2004 and December 2018. Patients were categorized into the overlap group (OG) or functional group (FG) based on the type of anastomosis used in EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. The surgical results and postoperative outcomes were compared. RESULTS We identified 69 propensity score-matched pairs among 440 patients who underwent LTG. There was no significant between-group difference in the median operative time, intraoperative blood, or number of lymph nodes resected. In terms of postoperative outcomes, the rates of all complications [Clavien-Dindo (CD) classification ≥II; OG 13.0 vs. FG 24.6%, respectively; P=0.082], complications more severe than CD grade III (OG 8.7 vs. FG 18.8%, respectively; P=0.084), and the occurrence of EJS leakage and stenosis more severe than CD grade III (OG 7.3% vs. FG 2.9%, P=0.245; OG 1.5 vs. FG 8.7%, P=0.115, respectively) were comparable. The median follow-up period was 830 days (range, 18 to 3376 d), and there were no differences in overall survival between the 2 groups. CONCLUSIONS There was no difference in surgical outcomes and overall survival based on the type of anastomosis used for EJS after LTG. Therefore, selection of anastomosis in EJS should be based on each surgeon's preference and experience.
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Wang Y, Liu Z, Shan F, Ying X, Zhang Y, Li S, Jia Y, Jiang Z, Yang X, Li B, Li Z, Ji J. Short-term outcomes after totally laparoscopic total gastrectomy with esophagojejunostomy constructed by π-shaped method versus overlap method. J Surg Oncol 2021; 124:1329-1337. [PMID: 34432310 DOI: 10.1002/jso.26642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Regarding the overlap anastomosis and recently introduced π-shaped anastomosis, there is no consensus on which intracorporeal esophagojejunostomy (EJS) methods are preferred using linear stapler in totally laparoscopic total gastrectomy (TLTG). This study aims to evaluate the short-term outcomes using two methods. METHODS Patients with upper gastric cancer underwent TLTG with either π-shaped (n = 48) or the modified overlap method using knotless barbed sutures (MOBS) (n = 37) were included in our study. Intraoperative and perioperative outcomes were compared. RESULTS All patients achieved R0 resection margin. The overall esophagojejunal (E-J)-related complications rate was 7.06%. There was no significant difference between the two groups in terms of postoperative complications, margin distance, numbers of lymph nodes (LNs), length of stay. In the π-shaped group, anastomosis time (19.61 ± 7.17 min vs. 27.09 ± 3.59 min, p < 0.001) was significantly lower. The consumable costs for surgery were similar (44 507.74¥ [42 933.03-46 937.29] vs. 43 718.36¥ [42 743.25-47 256.06], p = 0.825). The first defection time was significantly longer in π-shaped group (131.00 h [93.75-171.25] vs. 100.00 h [85.00-120.00], p = 0.026), whereas the other postoperative recovery parameters were similar. No mortality was observed. CONCLUSIONS Both methods showed similar short-term postoperative outcomes. The π-shaped technique was faster than the MOBS method without significantly increasing the supplies costs. Large prospective studies are warranted.
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Affiliation(s)
- Yinkui Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zining Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangji Ying
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuangxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yongning Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zijian Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xuesong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bailong Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
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Short-Term and Quality of Life Outcomes of Patients Using Linear or Circular Stapling in Esophagojejunostomy after Laparoscopic Total Gastrectomy. J Gastrointest Surg 2021; 25:1667-1676. [PMID: 32989689 DOI: 10.1007/s11605-020-04806-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies comparing the incidence of reflux esophagitis (RE) and patients' quality of life (QoL) when using circular stapler (CS) and linear stapler (LS) in esophagojejunostomy (EJS) after laparoscopic total gastrectomy (LTG) are rare, and certainly there are not enough to make a definitive decision on best practice. Presented herein is a study on the comparison of the short-term outcomes, QoL of the patients with the focus on the incidence of RE after both linear and circular stapling in LTG. METHODS From January 2014 to October 2018, 120 patients were analyzed; of these, 42 patients underwent laparoscopy-assisted total gastrectomy (LATG) with CS (CS group) and 78 patients who underwent totally laparoscopic total gastrectomy (TLTG) with LS (LS group). We examined the results obtained in terms of perioperative outcomes, reflux-related assessments (GerdQ questionnaire and endoscopy findings with all cases; 24-h pH monitoring with limited cases), and EORTC QLQ-C30 and QLQ-STO22. In addition, questionnaires were also supplied to patients and the results were recorded. RESULTS The incidence of anastomotic stenosis (7.1% vs. 0; P < 0.05) and the median intraoperative blood loss (180.0 vs. 100.0 mL; P < 0.05) of the CS group were higher than the LS group. The factor aside, no significant differences were observed between the two groups with regard to the incidence of RE assessed by the QLQ-STO22 reflux scale, the GerdQ scores, endoscopy (in all cases), or the percent time of pH > 7 (in limited cases) (P > 0.05). In the EORTC QLQ-C30 and QLQ-STO22, it was noted that the score of constipation [0 (0, 0) vs. 0 (0, 33.3); P = 0.028] and postoperative dysphagia [0 (0, 0) vs. 0 (0, 22.2); P = 0.046] of the LS group in a 1-year follow-up were lower than the CS group. CONCLUSIONS TLTG with LS generated better results than LATG with CS in terms of the incidence of anastomotic stenosis, intraoperative blood loss, and postoperative constipation and dysphagia. Furthermore, when compared with circular stapling, linear stapling in EJS did not increase the incidence of RE assessed by the QLQ-STO22 reflux scale, the GerdQ scores, endoscopy (in all cases), or the percent time of pH > 7 (in limited cases).
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Sugita H, Sakuramoto S, Oya S, Fujiwara N, Miyawaki Y, Satoh H, Okamoto K, Yamaguchi S, Koyama I. Linear stapler anastomosis for esophagogastrostomy in laparoscopic proximal gastrectomy reduce reflux esophagitis. Langenbecks Arch Surg 2021; 406:2709-2716. [PMID: 34155545 DOI: 10.1007/s00423-021-02250-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE There are various reconstruction methods for Laparoscopic proximal gastrectomy (LPG), such as esophagogastrostomy (EG), double-tract reconstruction, and jejunal interposition. We have performed EG using a circular stapler (OrVil) from 2013 and using a linear stapler from 2017. The aim of this retrospective study was to clarify which stapler is better for EG for LPG. METHODS The data of 84 patients who underwent EG for LPG between January 2013 and September 2019 were analyzed. EG with fundoplication was done using a circular stapler (OrVil) in 45 patients (CS group) and a linear stapler in 39 patients (LS group). The patients' medical records were reviewed. Clinical symptoms were obtained by interview at each outpatient consultation. All patients underwent postoperative 1-year follow-up endoscopy. To minimize bias between the two groups, propensity scores were calculated using a logistic regression model. After propensity-score matching, 60 patients (30 in the CS group and 30 in the LS group) were studied. RESULTS Patient characteristics, operative outcomes were similar in two groups. Anastomotic leakage occurred in one patient (3.3%) in both groups. Anastomotic stenosis occurred in five patients (16.7%) in the CS group and two patients (6.7%) in the LS group. The rate of patients with severe reflux esophagitis (grade C or D) was significantly lower in the LS group (3.4%) than in the CS group (26.7%) (p = 0.026). CONCLUSIONS EG with a linear stapler could reduce the risk of severe reflux esophagitis, and it could be a safe and feasible anastomosis for patients after LPG.
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Affiliation(s)
- Hirofumi Sugita
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan.
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Naoto Fujiwara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Hiroshi Satoh
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Kojun Okamoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
| | - Isamu Koyama
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan
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Ko CS, Choi NR, Kim BS, Yook JH, Kim MJ, Kim BS. Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy: A comparative study. World J Gastroenterol 2021; 27:2193-2204. [PMID: 34025073 PMCID: PMC8117731 DOI: 10.3748/wjg.v27.i18.2193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/21/2021] [Accepted: 04/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although several methods of totally laparoscopic total gastrectomy (TLTG) have been reported. The best anastomosis technique for LTG has not been established.
AIM To investigate the effectiveness and surgical outcomes of TLTG using the modified overlap method compared with open total gastrectomy (OTG) using the circular stapled method.
METHODS We performed 151 and 131 surgeries using TLTG with the modified overlap method and OTG for gastric cancer between March 2012 and December 2018. Surgical and oncological outcomes were compared between groups using propensity score matching. In addition, we analyzed the risk factors associated with postoperative complications.
RESULTS Patients who underwent TLTG were discharged earlier than those who underwent OTG [TLTG (9.62 ± 5.32) vs OTG (13.51 ± 10.67), P < 0.05]. Time to first flatus and soft diet were significantly shorter in TLTG group. The pain scores at all postoperative periods and administration of opioids were significantly lower in the TLTG group than in the OTG group. No significant difference in early, late and esophagojejunostomy (EJ)-related complications or 5-year recurrence free and overall survival between groups. Multivariate analysis demonstrated that body mass index [odds ratio (OR), 1.824; 95% confidence interval (CI): 1.029-3.234, P = 0.040] and American Society of Anaesthesiologists (ASA) score (OR, 3.154; 95%CI: 1.084-9.174, P = 0.035) were independent risk factors of early complications. Additionally, age was associated with ≥ 3 Clavien-Dindo classification and EJ-related complications.
CONCLUSION Although TLTG with the modified overlap method showed similar complication rate and oncological outcome with OTG, it yields lower pain score, earlier bowel recovery, and discharge. Surgeons should perform total gastrectomy cautiously and delicately in patients with obesity, high ASA scores, and older ages.
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Affiliation(s)
- Chang Seok Ko
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Nam Ryong Choi
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Byung Sik Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Jeong Hwan Yook
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Min-Ju Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
| | - Beom Su Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, South Korea
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Advantageous Short-Term Outcomes of Esophagojejunostomy Using a Linear Stapler Following Open Total Gastrectomy Compared with a Circular Stapler. World J Surg 2021; 45:2501-2509. [PMID: 33796923 DOI: 10.1007/s00268-021-06100-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophagojejunostomy is one of the most important surgical procedures in total gastrectomy. In the past, esophagojejunostomy was exclusively performed using a circular stapler in open total gastrectomy (OTG). With the increasing frequency of its use in laparoscopic gastrectomy, esophagojejunostomy using a linear stapler has been performed in OTG. However, it is still unclear whether the use of a linear stapler in esophagojejunostomy following OTG has any advantages compared with the conventional use of a circular stapler. METHODS A total of 298 patients who underwent OTG for gastric cancer between 2014 and 2019 were enrolled in this study. Patients were categorized into circular and linear groups (group C and group L) according to the stapler type used for the esophagojejunostomy. After propensity score matching, 136 patients (68 each in groups C and L) were selected to compare the surgical outcomes including incidence of esophagojejunostomy-related complications and postoperative nutritional status. RESULTS The median operation time was significantly longer in group L than in group C (261.5 min versus 325.5 min; P < 0.001). The incidence of esophagojejunostomy-related complications did not differ between the two groups (5.9% versus 2.9%; P = 0.68); however, no anastomotic stricture and bleeding occurred in group L. Bodyweight loss was significantly lower in group L than in group C at 6 months (15.9% versus 12.6%; P = 0.007) after surgery. CONCLUSIONS Esophagojejunostomy using a linear stapler following OTG is equally safe and possibly advantageous in anastomotic stricture, bleeding and nutritional status compared with the use of a circular stapler.
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Wang J, Yang J, Yang XW, Li XH, Yang JJ, Ji G. Comparison of Outcomes of Totally Laparoscopic Total Gastrectomy (Overlap Reconstruction) versus Laparoscopic-Assisted Total Gastrectomy for Advanced Siewert III Esophagogastric Junction Cancer and Gastric Cancer of Upper and Middle Third of Stomach: Study Protocol for a Single-Center Randomized Controlled Trial. Cancer Manag Res 2021; 13:595-604. [PMID: 33519239 PMCID: PMC7837541 DOI: 10.2147/cmar.s285598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Totally laparoscopic total gastrectomy (TLTG) using the overlap reconstruction method is associated with fewer postoperative complications and fast recovery than laparoscopic-assisted radical total gastrectomy (LATG). However, evidence on the safety and feasibility of TLTG (overlap reconstruction) in patients with advanced Siewert III esophagogastric junction cancer and gastric cancer of the upper and middle third of the stomach is scarce. Methods This study is a prospective, single-center, single-blind, two-arm randomized controlled trial designed to include 292 patients with advanced Siewert III esophagogastric junction cancer and gastric cancer of the upper and middle third of the stomach who will be randomly assigned to two groups: a TLTG overlap group (n=146) and an LATG group (n=146). The patients’ demographics, pathological characteristics, intraoperative variables, postoperative complications, postoperative recovery variables, 3-year disease-free survival and 3-year overall survival will be collected and analyzed. The primary outcome is the postoperative complications within 30 days after surgery including intra-abdominal hemorrhage, anastomotic leakage, duodenal stump fistula, pancreatic fistula, chyle leakage, abdominal infection, intestinal obstruction, wound complications, pulmonary infection, pleural effusion, pulmonary embolism, cardiovascular and cerebrovascular complications, and deep vein thrombosis. The secondary outcomes are the 3-year disease-free survival and 3-year overall survival. Discussion This trial will provide high-level evidence for the safety and feasibility of TLTG (overlap reconstruction) compared with LATG in advanced Siewert III esophagogastric junction cancer and the upper and middle third of gastric cancer. Trial Registration This trial has been registered at the Chinese Clinical Trial Registry: ChiCTR1900025667 (registration date: September 4, 2019).
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jun Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xue Wen Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xiao Hua Li
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jian Jun Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Gang Ji
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
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Esophagus two-step-cut overlap method in esophagojejunostomy after laparoscopic gastrectomy. Langenbecks Arch Surg 2021; 406:497-502. [PMID: 33420833 DOI: 10.1007/s00423-021-02079-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Esophagojejunostomy is a challenging step in laparoscopic gastrectomy. Although the overlap method is a safe and feasible approach for esophagojejunostomy, it has several technical limitations. We developed novel modifications for the overlap method to overcome these disadvantages. METHODS Forty-eight consecutive gastric cancer patients underwent totally laparoscopic total gastrectomy or laparoscopic proximal gastrectomy with double-tract reconstruction at our institution from January 2019 to April 2020 using the overlap method with the following modifications. The esophagus was initially rotated by 90° counterclockwise, followed by transection of two-thirds of the esophageal diameter. The unstapled esophagus was then transected with a harmonic ultrasonic scalpel to enable esophagostomy at the posterior side of the esophagus. A side-to-side esophagojejunostomy was then formed at the posterior side of the esophagus using an endoscopic linear stapler through the right lower trocar. The common entry hole was closed via hand sewing method using V-Loc suture. This procedure was termed "esophagus two-step-cut overlap method." RESULTS Only one patient suffered from esophagojejunal anastomotic leakage but subsequently recovered after conservative treatment. Patients did not experience anastomotic bleeding or stricture. CONCLUSION Our modified overlap method provides satisfactory surgical outcomes and overcomes several technical limitations, such as entering the false lumen of the esophagus, unnecessary pollution caused by nasogastric tube, and unintended left crus stapling during anastomosis.
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Braghetto I, Lanzarini E, Musleh M, GutiÉrrez L, Molina JC, Korn O, Figueroa M, Lasnibat JP, Orellana O. LESSONS LEARNED ANALYZING COMPLICATIONS AFTER LAPAROSCOPIC TOTAL GASTRECTOMY FOR GASTRIC CANCER. ACTA ACUST UNITED AC 2020; 33:e1539. [PMID: 33331434 PMCID: PMC7747491 DOI: 10.1590/0102-672020200003e1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/19/2020] [Indexed: 12/02/2022]
Abstract
Background:
Laparoscopic surgery has been gradually accepted as an option for the
surgical treatment ofgastric cancer. There are still points that are
controversial or situations that are eventually associated with
intra-operative difficulties or postoperative complications.
Aim:
To establish the relationship between the difficulties during the execution
of total gastrectomy and the occurrence of eventual postoperative
complications.
Method:
The operative protocols and postoperative evolution of 74 patients operated
for gastriccancer, who were subjected to laparoscopic total gastrectomy
(inclusion criteria) were reviewed. The intraoperative difficulties recorded
in the operative protocol and postoperative complications of a surgical
nature wereanalyzed (inclusion criteria). Postoperative medical
complications were excluded (exclusion criteria). For the discussion, an
extensive bibliographical review was carried out.
Results:
Intra-operative difficulties or complications reported correspond to 33/74
and of these; 18 events (54.5%) were related to postoperative complications
and six were absolutely unexpected. The more frequent were leaks of the
anastomosis and leaks of the duodenal stump; however, other rare
complications were observed. Seven were managed with conservative measures
and 17 (22.9%) required surgical re-exploration, with a postoperative
mortality of two patients (2.7%).
Conclusion:
We have learned that there are infrequent and unexpected complications; the
treating team must be mindful of and, in front of suspicion of
complications, anappropriate decision must be done which includes early
re-exploration. Finally, after the experience reported, some complications
should be avoided.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Enrique Lanzarini
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Maher Musleh
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis GutiÉrrez
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan Carlos Molina
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Manuel Figueroa
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan Pablo Lasnibat
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Omar Orellana
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
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Hangtian C, Huabing H, Tianhang L, Xiaoyi Y, Guoen F. Isoperistaltic versus antiperistaltic uncut Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a propensity score matched analysis. BMC Surg 2020; 20:274. [PMID: 33160348 PMCID: PMC7648979 DOI: 10.1186/s12893-020-00936-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022] Open
Abstract
Background The uncut Roux-en-y anastomosis (URYA) has some clinical advantages after distal gastrectomy (DG). Little evidence exists regarding the influence of peristalsis on this anastomosis. We aimed to evaluate short-term outcomes of isoperistaltic URYA (iso-URYA) comparing with antiperistaltic URYA (anti-URYA) after DG. Method Patients who underwent URYA for gastric cancer (GC) between January 2016 and December 2018 were selected from Shanghai Changhai Hospital, Navy Medical University. Short-term outcomes were compared between iso-URYA group and anti-URYA group after 1:1 propensity score matching (PSM). Result A total of 612 patients were selected. 392 patients underwent iso-URYA and 220 patients underwent anti-URYA. After PSM, 183 patients for each group were included in the final analysis. No differences were found between them in terms of short-term complications, nutritional status and quality of life 1 year after surgery. Endoscopic examination showed that anti-URYA group had more severe gastritis (P = 0.036). In addition, the recanalization rate was significantly higher when the afferent loop was blocked by stapler. Conclusion The iso-URYA and anti-URYA group present similar results in short term outcomes. Ligation blocking afferent loop leads to lower recanalization rate.
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Affiliation(s)
- Cui Hangtian
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Huang Huabing
- Department of Gastroenterology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Luo Tianhang
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Yin Xiaoyi
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China
| | - Fang Guoen
- Department of Gastrointestinal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China. .,Department of General Surgery, Changhai Hospital, No.168 Changhai Road, Yangpu District, Shanghai, 200433, China.
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Miyauchi W, Matsunaga T, Shishido Y, Miyatani K, Hanaki T, Kihara K, Yamamoto M, Tokuyasu N, Takano S, Sakamoto T, Honjo S, Saito H, Fujiwara Y. Comparisons of Postoperative Complications and Nutritional Status After Proximal Laparoscopic Gastrectomy with Esophagogastrostomy and Double-Tract Reconstruction. Yonago Acta Med 2020; 63:335-342. [PMID: 33253340 PMCID: PMC7683898 DOI: 10.33160/yam.2020.11.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to compare postoperative complications and nutritional status between esophagogastrostomy and double-tract reconstruction in patients who underwent laparoscopic proximal gastrectomy, and assess the advantages of both surgical procedures. METHODS Between 2010 and 2018, 47 cases underwent proximal gastrectomy with esophagogastrostomy (n = 23) or double-tract reconstruction (n = 24) at our institution for the treatment of clinical T1N0 adenocarcinoma located in the upper third of the stomach. Patient clinical characteristics, short-term outcomes, nutrition status, and skeletal muscle index were compared among the two groups. RESULTS There was no significant difference between esophagogastrostomy and double-tract reconstruction in terms of operation time, blood loss, and length of postoperative hospital stay. Reflux symptoms and anastomotic stenosis were significantly higher in the esophagogastrostomy group compared with the double-tract reconstruction group (P < 0.001 and P = 0.004, respectively). There was no significant difference in anastomotic leakage, surgical site infection, and pancreatic fistula. For the nutritional status, the decrease rate of cholinesterase was significantly higher in the esophagogastrostomy group compared with the double-tract reconstruction group at 6 months (P = 0.008) There was no significant difference in the decrease rate of skeletal muscle mass index at 1 year after surgery. CONCLUSION Compared with esophagogastrostomy, double-tract reconstruction tends to have better short-term nutritional status and postoperative outcomes in terms of preventing the occurrence of gastroesophageal reflux and anastomosis stenosis. These findings suggest that double-tract reconstruction may be a useful method in laparoscopic proximal gastrectomy.
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Affiliation(s)
- Wataru Miyauchi
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Yuji Shishido
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Kozo Miyatani
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Takehiko Hanaki
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Kyoichi Kihara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Manabu Yamamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Naruo Tokuyasu
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Shuichi Takano
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Teruhisa Sakamoto
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Soichiro Honjo
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
| | - Hiroaki Saito
- Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori 680-8517, Japan
| | - Yoshiyuki Fujiwara
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan and
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Chen XD, He FQ, Liao MS, Chen M. Laparoscopic versus open transhiatal approach for adenocarcinoma of the esophagogastric junction: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 47:778-788. [PMID: 33268214 DOI: 10.1016/j.ejso.2020.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/04/2020] [Accepted: 10/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Laparoscopic transhiatal approach (LTH) has gained growing popularity in the treatment of AEG. However, its safety and efficacy need to be evaluated. METHODS Original studies comparing LTH with open transhiatal approach (OTH) were searched. Meta-analysis was performed using RevMan 5.3. RESULTS Nine studies involving 2149 patients were eligible. Compared with OTH, LTH was associated with longer operation time (mean difference [MD] = 31min, 95%CI [20,41], P < 0.001) while less blood loss (MD = -103ml [-135, -72], P < 0.001), and harvested similar number of lymph nodes (MD = 0.1 [-1.2, 1.4], P = 0.89). There were no differences in time to ambulation (MD = -0.79 days [-1.77, 0.20], P = 0.12) or time to first flatus (MD = -0.82 days [-1.76, 0.11], P = 0.08); however, LTH was associated with shorter postoperative hospital stay (MD = -1.70 days [-2.34, -1.05], P < 0.001). The mortality after surgery was comparable for LTH and OTH (risk difference [RD] = -0.00 [-0.01, 0.01], P = 0.55). The incidence of total major complications was similar in LTH (6.1%) and OTH (8.4%) (RD = -0.02 [-0.05, 0.01], P = 0.12); there were no significant differences in the incidence of each complication. Furthermore, LTH achieved similar 2-year overall survival (OS) rate (risk ratio [RR] = 1.17 [0.86, 1.60], P = 0.31) while higher 5-year OS rate (RR = 1.43 [1.18, 1.73], P = 0.0003) and significant improvement of OS (univariable hazard ratio = 0.65 [0.50, 0.84], P = 0.0009; multivariable hazard ratio = 0.59 [0.44, 0.80], P = 0.0006). CONCLUSIONS LTH is feasible and safe for AEG, and may provide more favorable short-term outcomes and potential long-term survival benefit, which needs to be confirmed by randomized trials.
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Affiliation(s)
- Xiao-Dong Chen
- Department of Gastrointestinal Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, China.
| | - Fu-Qian He
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, China.
| | - Mao-Shan Liao
- Department of Laboratory Medicine, Santai People's Hospital, China
| | - Mi Chen
- Department of Surgery, Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, China
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Han WH, Oh YJ, Eom BW, Yoon HM, Kim YW, Ryu KW. A comparative study of the short-term operative outcome between intracorporeal and extracorporeal anastomoses during laparoscopic total gastrectomy. Surg Endosc 2020; 35:1602-1609. [PMID: 32270275 DOI: 10.1007/s00464-020-07539-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several studies have reported that intracorporeal anastomosis reduces the requirement for the additional incision for anastomosis, resulting in early recovery compared to extracorporeal anastomosis during laparoscopic distal gastrectomy. However, few studies have investigated postoperative outcome after laparoscopic total gastrectomy (LTG). We compared short-term postoperative outcomes between totally laparoscopic total gastrectomy (TLTG) with intracorporeal anastomosis and conventional laparoscopy-assisted total gastrectomy (LATG) with extracorporeal anastomosis for gastric cancer. METHODS This retrospective case-control study included 202 patients who underwent LTG from January 2012 to June 2019. LATG was performed in the period before July 2015; TLTG was performed in the period after July 2015. Postoperative short-term outcomes and white blood cell (WBC) count, and C-reactive protein (CRP) levels at 1, 3, and 5 days postoperatively were compared between the groups. RESULTS One hundred ten patients underwent LATG; 92 underwent TLTG. The pathologic stage was significantly higher in the TLTG group (p = 0.010). Intraoperative estimated blood loss was significantly lower in the TLTG group than in the LATG group (median [range]: 100 [50-150] mL versus [vs.] 50 [30-100], p < 0.001). Postoperative hospital stay duration was significantly longer in the TLTG group than in the LATG group (median [range]: 7 [7-9] days vs. 8 [7-11], p < 0.001). WBC count (6.3 109/L ± 1.9 vs. 8.2 ± 2.5, p = 0.004) and CRP levels (8.3 mg/L ± 6.1 vs. 13.3 ± 9.4, p < 0.001) were lower in the LATG group than in the TLTG group. The overall complication rate was higher in the TLTG group than in the LATG group (16.3% vs. 32.6%, p = 0.007). A higher American Society of Anesthesiologist score was the only significant risk factor for postoperative complications. CONCLUSION Both procedures are feasible, although TLTG has more risk for postoperative complications than LATG. TLTG should be improved to reduce postoperative complications and provide better postoperative outcomes.
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Affiliation(s)
- Won Ho Han
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Yoon Jung Oh
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, Research Institute & Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, 410-769, Republic of Korea.
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Ishibashi Y, Oka S, Kanda S, Yube Y, Kohira Y, Kaji S, Egawa H, Jianzhong W, Zhang S, Fukunaga T. Hemi-double stapling technique performed with a transorally inserted anvil for esophagojejunostomy in the surgical treatment of gastric cancer. Asian J Endosc Surg 2020; 13:168-174. [PMID: 31099183 DOI: 10.1111/ases.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A transorally inserted anvil has been developed to facilitate the creation of a stapled anastomosis without the need for a purse string to secure the anvil into place during laparoscopic total gastrectomy (LTG). We describe a hemi-double stapling technique and application of a transorally inserted anvil for esophagojejunostomy during LTG, and we report the results of a retrospective study in which we examined the feasibility and safety of this method. We also describe the key technical details of the method. METHODS Our anastomotic method has four chief features: (a) the esophagus is cut at a slant, and its left cut end is cut and punched for the hemi-double stapling technique; (b) the anvil and circular stapler are connected, placing the distal jejunum in cranial traction; (c) a single layer of sutures is used to correct dog-earing and overlapping, and these points are completely closed with Lembert sutures; and (d) the jejunal limb is fixed to the duodenal stump to prevent kinking of the jejunal limb and to decrease tension on the anastomosis. RESULTS This method has been used in 53 patients thus far. LTG with Roux-en-Y reconstruction was successful in all patients, and there was no need for conversion to open surgery. The mean operative time was 313 minutes, and the mean blood loss was 106 mL. The mean postoperative hospital stay was 18 days. There was no anastomotic leakage or stenosis. CONCLUSION Hemi-double stapling technique with a transorally inserted anvil for LTG can be performed safely and easily and safely. It can also product good outcomes.
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Affiliation(s)
- Yuji Ishibashi
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinichi Oka
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoshi Kanda
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukinori Yube
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshinori Kohira
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Sanae Kaji
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Egawa
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Wu Jianzhong
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shun Zhang
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Zhang S, Fukunaga T, Oka S, Orita H, Kaji S, Yube Y, Yamauchi S, Kohira Y, Egawa H. Concerns of quality, utility, and reliability of laparoscopic gastrectomy for gastric cancer in public video sharing platform. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:196. [PMID: 32309343 PMCID: PMC7154475 DOI: 10.21037/atm.2020.01.78] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The rapid expansion of laparoscopic gastrectomy (LG) for gastric cancer has generated interest among surgeons. The adequate dissemination of correct information about such advanced laparoscopic surgery can certainly be useful for surgeons and trainees. Online video resources such as YouTube are frequently used for education. This study aimed to evaluate the quality, utility, and completeness of LG videos for gastric cancer on the video website YouTube. Methods The terms “laparoscopic gastrectomy” and “gastric cancer” were searched on YouTube on August 16, 2019. The first 100 videos in three sorting categories (website’s default setting, view count, and length of duration) were checked by two experienced surgeons. The popularity was evaluated with the video power index (VPI). The reliability was measured using the Journal of American Medical Association (JAMA) benchmark criteria. The educational value and completeness were evaluated with a checklist developed by the researchers. Results A total of 102 videos were analyzed. Laparoscopic distal gastrectomy (LDG) and laparoscopic total gastrectomy were the most frequently recorded techniques. Lymph node (LN) dissection was the most frequently covered topic (89.2%), followed in descending order by GI reconstruction (87.3%). The mean VPI, JAMA benchmark score and completeness score of all videos were 2.63, 1.94 and 8.53, respectively. The types of sources were as follows: private users, 73 (71.6%); academic institutions, 20 (19.6%); and others, 9 (8%). A total of 97 videos with an identifiable primary surgeon originated from eighteen different countries. Conclusions Laparoscopic videos represented by YouTube represent a useful and appropriate educational tool. However, the quality of videos varied, and the level of information incompleteness was fairly high due to insufficient reviews. The role of private uploaders and academic institutions in surgical education cannot be overestimated. It is necessary that surgeon trainers and surgical educators critically analyze the quality of video content and exercise responsibility in directing trainee surgeons. In the current era, it is best for trainees to search for peer-reviewed content.
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Affiliation(s)
- Shun Zhang
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China.,Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University Hospital, Tokyo, Japan
| | - Tetsu Fukunaga
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Shinichi Oka
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Hajime Orita
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Sanae Kaji
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Yukinori Yube
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Suguru Yamauchi
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Yoshinori Kohira
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
| | - Hiroyuki Egawa
- Department of Gastrointestinal Surgery, Shanghai East Hospital (East Hospital Affiliated to Tongji University), Shanghai 200120, China
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Sun Z, Zheng X, Chen G, Wang L, Sang Q, Xu G, Zhang N, Aminbuhe. Technical details of and prognosis for the "China stitch", a novel technique for totally laparoscopic hand-sewn esophagojejunostomy. Biosci Trends 2020; 14:56-63. [PMID: 32092746 DOI: 10.5582/bst.2019.01329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The current study describes the technical details of and the clinical prognosis for the "China stitch", a novel technique for hand-sewn esophagojejunostomy in totally laparoscopic total gastrectomy. This study also explores the feasibility and safety of the technique. Clinical data of 20 patients with esophagogastric junction cancer in Beijing Shijitan Hospital, Capital Medical University from January 2017 to April 2018 were retrospectively analyzed. All 20 patients underwent esophagojejunostomy via a novel hand-sewn technique that uses traction to turn the left or right wall of the esophagus into an anterior wall. This avoids the difficulty of suturing the posterior wall. All patients were followed until June 2019. All 20 patients successfully underwent the procedure. The mean operating time was 216.5 ± 24.9 (176-254) min, the mean hand-sewn reconstruction time was 44.4 ± 9.4 (26-61) min, intraoperative bleeding was 141.2 ± 24.9 (130-160) mL, and the number of resected lymph nodes was 23 ± 8 (14-33). After surgery, there was one case of anastomotic leakage and one case of anastomotic stenosis, but both were alleviated with conservative treatment. The mean duration of follow-up was 15 (4-33) months. There was no significant difference in postoperative complications of and short-term oncologic prognosis for the 20 patients who underwent hand-sewn esophagojejunostomy and the 21 patients who underwent mechanical esophagojejunostomy during the same period. In conclusion, the "China stitch", a novel hand-sewn technique, is a cost-effective, safe, and reliable method for esophagojejunostomy in totally laparoscopic total gastrectomy.
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Affiliation(s)
- Zhipeng Sun
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
| | - Xuejing Zheng
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
| | - Guanyang Chen
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
| | - Liang Wang
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
| | - Qing Sang
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
| | - Guangzhong Xu
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
| | - Nengwei Zhang
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
| | - Aminbuhe
- Oncology Surgery Department, Beijing Shijitan Hospital, Capital Medical University (Peking University Ninth School of Clinical Medicine), Beijing, China
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Gu L, Zhang K, Shen Z, Wang X, Zhu H, Pan J, Zhong X, Khadaroo PA, Chen P. Risk Factors for Duodenal Stump Leakage after Laparoscopic Gastrectomy for Gastric Cancer. J Gastric Cancer 2020; 20:81-94. [PMID: 32269847 PMCID: PMC7105415 DOI: 10.5230/jgc.2020.20.e4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/02/2020] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose Duodenal stump leakage (DSL) is a potentially fatal complication that can occur after gastrectomy, but its underlying risk factors are unclear. This study aimed to investigate the risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer (GC). Materials and Methods Relevant data were collected from several prospective databases to retrospectively analyze the data of GC patients who underwent Billroth II (B-II) or Roux-en-Y (R-Y) reconstruction after laparoscopic gastrectomy from 2 institutions (Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and HwaMei Hospital, University of Chinese Academy of Sciences). The DSL risk factors were analyzed using univariate and multivariate analysis regression. Results A total of 810 patients were eligible for our analysis (426 with R-Y, 384 with B-II with Braun). Eleven patients had DSL (1.36%). Body mass index (BMI), elevated preoperative C-reactive protein (CRP) level, and unreinforced duodenal stump were the independent risk factors for DSL. DSL was diagnosed in 2–12 days, with a median of 8 days. Seven patients received conservative treatment, 3 patients received puncture treatment, and only 1 patient required reoperation. All patients recovered successfully after treatment. Conclusions The risk factors of DSL were BMI ≥24 kg/m2, elevated preoperative CRP level, and unreinforced duodenal stump. Nonsurgical treatments for DSL are preferred.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Kang Zhang
- Department of Clinical Medicine, Medical College of Ningbo University, Ningbo, China
| | - Zefeng Shen
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianfa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hepan Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junhai Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Zhong
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Parikshit Asutosh Khadaroo
- Department of Clinical Medicine, Monash University School of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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Shen J, Ma X, Yang J, Zhang JP. Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer. World J Gastrointest Oncol 2020; 12:21-36. [PMID: 31966911 PMCID: PMC6960078 DOI: 10.4251/wjgo.v12.i1.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
In addition to the popularity of laparoscopic gastrectomy (LG), many reconstructive procedures after LG have been reported. Surgical resection and lymphatic dissection determine long-term survival; however, the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer (GC). Presently, no consensus exists regarding the optimal reconstructive procedure. In this review, the current state of digestive tract reconstruction after LG is reviewed. According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction, we divide these reconstruction procedures into three categories consistent with the resection procedures. We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes (length of surgery and blood loss) and postoperative complications (anastomotic leakage and stricture) to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.
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Affiliation(s)
- Jian Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang Ma
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jing Yang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jian-Ping Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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Overlap method versus functional method for esophagojejunal reconstruction using totally laparoscopic total gastrectomy. Surg Endosc 2020; 35:130-138. [PMID: 31938929 DOI: 10.1007/s00464-020-07370-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 01/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic intracorporeal esophagojejunostomy (EJ) is a useful method in totally laparoscopic total gastrectomy (TLTG) for treating upper-third gastric cancer. The two methods of laparoscopic intracorporeal EJ-functional and overlap-have not been compared side-by-side in terms of safety and feasibility. METHODS Retrospective review and analysis of the data of 490 consecutive patients who underwent TLTG by either functional method (n = 365) or overlap (n = 125) method for upper- or middle-third gastric cancer was conducted between January, 2011 and May, 2018 at Asan Medical Center (Seoul, Korea). One-to-one propensity score matching (PSM) was performed to compare age, sex, body mass index, American Society of Anesthesiologist score, the presence of comorbidity, number of comorbidities, clinical T stage, clinical nodal stage, clinical TNM stage, history of previous abdominal surgery, and combined surgery. After PSM, 244 patients were divided into functional method group and overlap method group (n = 122, each). The surgical outcomes and EJ-related complications were compared between the two groups. RESULTS No significant difference was found between the two groups in terms of early surgical outcomes such as operative time, time to first flatus, postoperative hospital stay, transfusion during surgery, transfusion after surgery, and administration of analgesics. However, the pain score was significantly lower in overlap method group (6.21 ± 1.83) than functional method group (6.97 ± 2.09, p < 0.05). The overlap method was also associated with significantly fewer late complications (3.28% vs. 12.30%; p < 0.05), lower Clavien-Dindo classification grade (p < 0.05), and fewer EJ-related complications (0.82% vs. 6.56%; p < 0.05), as compared with the functional method. CONCLUSION The overlap method was safer and more feasible than the functional method for TLTG in gastric cancer patients, based on the finding of significantly lower incidence of EJ-related complications.
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Murakami K, Obama K, Tsunoda S, Hisamori S, Nishigori T, Hida K, Kanaya S, Satoh S, Manaka D, Yamamoto M, Kadokawa Y, Itami A, Okabe H, Hata H, Tanaka E, Yamashita Y, Kondo M, Hosogi H, Hoshino N, Tanaka S, Sakai Y. Linear or circular stapler? A propensity score-matched, multicenter analysis of intracorporeal esophagojejunostomy following totally laparoscopic total gastrectomy. Surg Endosc 2019; 34:5265-5273. [PMID: 31820152 DOI: 10.1007/s00464-019-07313-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/28/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG. METHODS We collected data on 829 consecutive gastric cancer patients who underwent TLTG reconstructed by the Roux-en-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups. RESULTS After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%, p = 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%, p = 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%, p = 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%, p = 0.771). CONCLUSION The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis.
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Affiliation(s)
- Katsuhiro Murakami
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Seiichiro Kanaya
- Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Seiji Satoh
- Department of Gastroenterological Surgery and Oncology, Himeji Medical Center, Himeji, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Dai Manaka
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Michihiro Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Atsushi Itami
- Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Hiroshi Okabe
- Department of Surgery, Otsu City Hospital, Otsu, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Hiroaki Hata
- Department of Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Eiji Tanaka
- Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Yoshito Yamashita
- Department of Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Hisahiro Hosogi
- Department of Surgery, Kyoto City Hospital, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54, Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
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Chen XH, Hu YF, Luo J, Chen YH, Liu H, Lin T, Chen H, Li GX, Yu J. The safety of esophagojejunostomy via a transorally inserted-anvil method vs extracorporeal anastomosis using a circular stapler during total gastrectomy for Siewert type 2 adenocarcinoma of the esophagogastric junction. Gastroenterol Rep (Oxf) 2019; 8:242-251. [PMID: 32665856 PMCID: PMC7333922 DOI: 10.1093/gastro/goz046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/08/2019] [Accepted: 05/05/2019] [Indexed: 12/23/2022] Open
Abstract
Background Intracorporeal esophagojejunostomy via a transorally inserted-anvil method during laparoscopic total gastrectomy (LTG) for upper gastric cancer has been demonstrated to be feasible, but the use of this assessment exclusively for Siewert type 2 adenocarcinoma of the esophagogastric junction (AEG) has not been reported. Methods A total of 428 consecutive gastric-cancer patients who underwent LTG in Nanfang Hospital from January 2008 to December 2016 were reviewed. Among these patients, 98 were classified as Siewert type 2 AEG. The patients underwent intracorporeal esophagojejunostomy through either a transorally inserted-anvil method (n = 27) or extracorporeal anastomosis usinga circular stapler (n = 71). After generating propensity scores with covariates that were associated with developing anastomotic leakage, 26 patients who underwent esophagojejunostomy via the transorally inserted-anvil method (transoral group) were 1:1 matched with 26 patients who underwent the procedure via extracorporeal anastomosis using a circular stapler (extracorporeal group). The safety after 30 days post-operatively was compared between the two groups. Results The transoral group and extracorporeal group were balanced regarding the baseline variables. The operative time, reconstruction duration, number of dissected lymph nodes, length of the proximal resection margins, estimated blood loss, intra-operative complication rate, and post-operative recovery course were not significantly different between the two groups. The mean anvil-insertion completion time (9.7 ± 3.0 vs 13.4 ± 2.0 minutes, P < 0.001) and the median incision length (5.5 vs 7.0 cm, P < 0.001) in the transoral group were shorter than those in the extracorporeal group. The incidence of post-operative complications (26.9% vs 23.1%, P = 0.749) and the classification of complication severity (P = 0.939) were similar between the two groups. Conclusions Intracorporeal esophagojejunostomy through a transorally inserted-anvil method may be a potentially safe approach to simplify and optimize the procedure during LTG for Siewert type 2 AEG.
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Affiliation(s)
- Xin-Hua Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Yan-Feng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Jun Luo
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Yue-Hong Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Tian Lin
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Hao Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Guo-Xin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P. R. China
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Takayama Y, Kaneoka Y, Maeda A, Fukami Y, Takahashi T, Uji M. A Novel Technique of Hand-Sewn Purse-String Suturing by Double Ligation Method (DLM) for Intracorporeal Circular Esophagojejunostomy. J Gastric Cancer 2019; 19:290-300. [PMID: 31598372 PMCID: PMC6769370 DOI: 10.5230/jgc.2019.19.e26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose The optimal method for intracorporeal esophagojejunostomy remains unclear because a purse-string suture for fixing the anvil into the esophagus is difficult to perform with a laparoscopic approach. Therefore, this study aimed to evaluate our novel technique to fix the anvil into the esophagus. Materials and Methods This retrospective study included 202 patients who were treated at our institution with an intracorporeal circular esophagojejunostomy in a laparoscopy-assisted total gastrectomy with a Roux-en-Y reconstruction (166 cases) or a laparoscopy-assisted proximal gastrectomy with jejunal interposition (36 cases). After incising 3/4 of the esophageal wall, a hand-sewn purse-string suture was placed on the esophagus. Next, the anvil head of a circular stapler was introduced into the esophagus. Finally, the circular esophagojejunostomy was performed laparoscopically. The clinical characteristics and surgical outcomes were evaluated and compared with those of other methods. Results The average operation time was 200.3 minutes. The average hand-sewn purse-string suturing time was 6.4 minutes. The overall incidence of postoperative complications (Clavien–Dindo classification grade ≥II) was 26%. The number of patients with an anastomotic leakage and stenosis at the esophagojejunostomy site were 4 (2.0%) and 12 (6.0%), respectively. All patients with stenosis were successfully treated by endoscopic balloon dilatation. There was no mortality. Regarding the materials and devices for anvil fixation, only 1 absorbable thread was needed. Conclusions Our procedure for hand-sewn purse-string suturing with the double ligation method is simple and safe.
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Affiliation(s)
- Yuichi Takayama
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yuji Kaneoka
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuyuki Fukami
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Masahito Uji
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Japan
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Park KB, Kim EY, Song KY. Esophagojejunal Anastomosis after Laparoscopic Total Gastrectomy for Gastric Cancer: Circular versus Linear Stapling. J Gastric Cancer 2019; 19:344-354. [PMID: 31598376 PMCID: PMC6769364 DOI: 10.5230/jgc.2019.19.e34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose No standard technique has been established for esophagojejunal anastomosis during laparoscopic total gastrectomy (LTG) for gastric cancer owing to the technical difficulty and high complication rate of this procedure. This study was performed to compare the short-term outcomes of circular and linear stapling methods after LTG. Materials and Methods A total of 106 patients treated between July 2010 and July 2018 were divided into 2 groups according to the following anastomosis procedures: hemi-double-stapling technique (HDST; circular stapling method; group C, n=77) or overlap method (linear stapling method; group L, n= 29). The clinicopathological features and postoperative outcomes, including complications, were analyzed. Multivariate analysis was performed using a logistic regression model to identify the independent risk factors for anastomotic complications. Results The incidence of anastomotic complications was significantly higher in group C than in group L (28.0% vs. 6.9%, P=0.031). The incidence of anastomosis leakage did not differ between the groups (6.5% vs. 6.9%, P=1.000). However, anastomosis stricture occurred only in group C (13% vs. 0%, P=0.018). Multivariate analysis showed that the anastomosis type was significantly related to the risk of anastomotic complications (P=0.045). Conclusions The overlap method was superior to the HDST with respect to anastomotic complications, especially anastomosis stricture.
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Affiliation(s)
- Ki Bum Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Young Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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