Case Control Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1354-1362
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1354
Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer: A prospective case–control study
Zhen Wu, Zhi-Gang Zhou, Ling-Yu Li, Wen-Jing Gao, Ting Yu
Zhen Wu, Zhi-Gang Zhou, Ling-Yu Li, Wen-Jing Gao, Ting Yu, Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
Author contributions: Wu Z participated in the study design, performed the experiments, and drafted the manuscript; Li LY and Gao WJ analyzed the data; Yu T collected the samples and modified the manuscript; and Zhou ZG conceived and supervised the study.
Institutional review board statement: The study design was approved by the Ethics Committee of Yixing Traditional Chinese Medicine Hospital.
Informed consent statement: Informed consent was obtained from all the study participants.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: All datasets are available from the corresponding author upon request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the study was conducted according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Gang Zhou, MM, Attending Doctor, Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, No. 128 Yangquan East Road, Yicheng Street, Wuxi 214200, Jiangsu Province, China. zzgzhigang537@163.com
Received: May 4, 2023
Peer-review started: May 4, 2023
First decision: May 15, 2023
Revised: May 29, 2023
Accepted: June 2, 2023
Article in press: June 2, 2023
Published online: July 27, 2023
Abstract
BACKGROUND

Gastric cancer is the most common cause of cancer-related deaths, and is classified according to its location in the proximal, middle, or distal stomach. Surgical resection is the primary approach for treating gastric cancer. This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.

AIM

To explore the efficacy of different staplers and digestive tract reconstruction (DTR) methods after radical gastrectomy and their influence on prognosis.

METHODS

Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study, with a follow-up period of 12-26 mo. The patients were assigned to four groups based on the stapler and DTR plan as follows: Billroth Ⅰ (B-I) reconstruction + linear stapler group (group A, 22 cases), B-I reconstruction + circular stapler group (group B, 22 cases), Billroth II (B-II) reconstruction + linear stapler group (group C, 22 cases), and B-II reconstruction + circular stapler group (group D, 21 cases). The pathological parameters, postoperative gastrointestinal function recovery, postoperative complications, and quality of life (QOL) were compared among the four groups.

RESULTS

No significant differences in the maximum diameter of the gastric tumors, total number of lymph nodes dissected, drainage tube removal time, QLQ (QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively, and incidence of complications were observed among the four groups (P > 0.05). However, groups A and C (linear stapler) had significantly lower intraoperative blood loss and significantly shorter anastomosis time, operation time, first fluid diet intake time, first exhaust time, and length of postoperative hospital stay (P < 0.05) than groups B and D (circular stapler).

CONCLUSION

Linear staplers offer several advantages for postoperative recovery. B-I and B-II reconstruction methods had similar effects on QOL. The optimal solution can be selected according to individual conditions and postoperative convenience.

Keywords: Gastric cancer, Distal radical gastrectomy, Reconstruction of digestive tract, Stapler, Quality of life, Prognosis

Core Tip: To explore the efficacy of different staplers and digestive tract reconstruction (DTR) methods after radical gastrectomy for distal gastric cancer, 87 patients who underwent radical gastrectomy for distal gastric cancer were assigned to four groups: Billroth I (B-I) + linear stapler, B-I reconstruction + circular stapler, Billroth II (B-II) + linear stapler, and B-II + circular stapler. The analysis of various indicators revealed that the linear stapler has greater advantages in postoperative recovery, and that different DTR methods (B-I and B-II) have similar effects on the long-term quality of life of patients after surgery.