Shi JK, Wang B, Zhang XS, Lv P, Chen YL, Ren SY. Multifactor analysis of the technique in total laparoscopic gastric cancer. World J Gastrointest Surg 2023; 15(9): 2003-2011 [PMID: 37901745 DOI: 10.4240/wjgs.v15.i9.2003]
Corresponding Author of This Article
Shuang-Yi Ren, MD, Attending Doctor, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian 116011, Liaoning Province, China. pao54313345736@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jia-Kun Shi, Pin Lv, Yun-Long Chen, Department of Gastrointestinal Surgery, Dalian Friendship Hospital, Dalian 116000, Liaoning Province, China
Bo Wang, Xin-Sheng Zhang, Shuang-Yi Ren, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Author contributions: Shi JK and Wang B proposed the concepts for this study; Zhang XS and Lv P collected the data; Shi JK, Chen LY, and Ren SY contributed to formal analysis; Ren SY and Shi JK contributed to the investigation; Shi JK, Chen LY, and Ren SY contributed to the methodology; Wang B supervised the research; Shi JK validated this study; Shi JK and Ren SY contributed to the visualization of research; Shi JK, Wang B, Zhang XS, Lv P, Chen LY, and Ren SY reviewed and edited the manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board of Dalian Friendship Hospital.
Informed consent statement: This study has obtained informed consent from patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Shuang-Yi Ren, MD, Attending Doctor, Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, No. 467 Zhongshan Road, Shahekou District, Dalian 116011, Liaoning Province, China. pao54313345736@126.com
Received: June 30, 2023 Peer-review started: June 30, 2023 First decision: July 18, 2023 Revised: July 24, 2023 Accepted: August 8, 2023 Article in press: August 8, 2023 Published online: September 27, 2023 Processing time: 84 Days and 4.1 Hours
Abstract
BACKGROUND
Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy. However, using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration. In order to overcome these issues and improve patient prognosis, muscle flap reconstruction technique has emerged. Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue. By covering the anastomotic site with muscle tissue, it not only enhances the stability of the anastomosis site but also increases blood supply, promoting healing and recovery of the anastomosis. Therefore, the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied.
AIM
To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients’ prognosis.
METHODS
The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022. All patients underwent esophagogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy. Perioperative indicators were determined, and patients were followed up for 1 year. Furthermore, patient outcomes were observed within 1 year, followed by patient classification based on different outcomes. Moreover, clinicopathological parameters were observed and relevant factors affecting patient prognosis were analyzed.
RESULTS
The operation time was 318 ± 43 min, the formation time of esophageal double muscle flap anastomosis was 110 ± 13 min, the number of lymph node dissections was 26 ± 6, the incision length was 3 ± 0.6 cm, intraoperative bleeding volume was 48 ± 15 mL, first anal exhaust time was 5.3 ± 1.8 d, first meal time was 6.0 ± 1.6 d, length of hospital stay was 11.8 ± 2.5, and treatment cost was 5.8 ± 0.7 thousand yuan. The patient experienced three postoperative complications: 2 cases of pulmonary infection and 1 case of respiratory discomfort. During 1-year follow-up, 50 patients survived and 10 died. Univariate analysis revealed that histological types, tumor size, tumor-node-metastasis staging, vascular invasion, and postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting the prognosis of surviving patients. Furthermore, Cox regression analysis revealed that postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting patient prognosis. The survival time of the survival group was significantly higher than that of the death group (P < 0.05).
CONCLUSION
Esophagogastric anastomotic using muscle flap reconstruction exhibits good effects on patients who undergo total abdominal gastrectomy for cancer. Postoperative adjuvant radiotherapy and chemotherapy are the main factors affecting patient prognosis.
Core Tip: This study evaluated the effectiveness of esophagogastric anastomosis using muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer. The study found that this technique had positive effects on patient outcomes, and postoperative adjuvant radiotherapy and chemotherapy were important factors affecting prognosis. Univariate analysis revealed that histological types, tumor size, tumor-node-metastasis staging, vascular invasion, and postoperative adjuvant radiotherapy and chemotherapy were major factors affecting the prognosis of surviving patients. Cox regression analysis showed that postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting overall patient prognosis. The findings of this study may contribute to improving treatment options and decision-making for patients with gastric cancer undergoing total abdominal gastrectomy, ultimately leading to better patient outcomes.
