Dong TX, Wang D, Zhao Q, Zhang ZD, Zhao XF, Tan BB, Liu Y, Liu QW, Yang PG, Ding PA, Zheng T, Li Y, Liu ZJ. Comparative analysis of two digestive tract reconstruction methods in total laparoscopic radical total gastrectomy. World J Gastrointest Surg 2024; 16(4): 1109-1120 [PMID: 38690052 DOI: 10.4240/wjgs.v16.i4.1109]
Corresponding Author of This Article
Dong Wang, MD, Doctor, Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, No. 12 Jiankang Road, Changan District, Shijiazhuang 050011, Hebei Province, China. 15833981527@163.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/
Tian-Xiang Dong, Dong Wang, Qun Zhao, Zhi-Dong Zhang, Xue-Feng Zhao, Bi-Bo Tan, Yu Liu, Qing-Wei Liu, Pei-Gang Yang, Ping-An Ding, Tao Zheng, Yong Li, Zi-Jing Liu, Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, Shijiazhuang 050011, Hebei Province, China
Author contributions: Wang D contributed to the conception and design; Wang D and Zhao Q contributed to the provision of study materials or patients; Dong TX and Ding PA contributed to the collection and assembly of data, data analysis and interpretation; all authors contributed to the manuscript writing and final approval of manuscript.
Supported by2024 Government-funded Clinical Medicine Talent Project, No. ZF2024122.
Institutional review board statement: This study was reviewed and approved for publication by the Medical Ethics Committee of the Fourth Hospital of Hebei Medical University, No. 2022KY136.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at 15833981527@163.com.
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: Dong Wang, MD, Doctor, Third Department of Surgery of the Fourth Hospital of Hebei Medical University, Hebei Key Laboratory of Precision Diagnosis and Comprehensive Treatment of Gastric Cancer, No. 12 Jiankang Road, Changan District, Shijiazhuang 050011, Hebei Province, China. 15833981527@163.com
Received: January 19, 2024 Peer-review started: January 19, 2024 First decision: February 5, 2024 Revised: February 27, 2024 Accepted: March 26, 2024 Article in press: March 26, 2024 Published online: April 27, 2024
Abstract
BACKGROUND
The incidence of gastric cancer has significantly increased in recent years. Surgical resection is the main treatment, but the method of digestive tract reconstruction after gastric cancer surgery remains controversial. In the current study, we sought to explore a reasonable method of digestive tract reconstruction and improve the quality of life and nutritional status of patients after surgery. To this end, we statistically analyzed the clinical results of patients with gastric cancer who underwent jejunal interposition double-tract reconstruction (DTR) and esophageal jejunum Roux-en-Y reconstruction (RY).
AIM
To explore the application effect of DTR in total laparoscopic radical total gastrectomy (TLTG) and evaluate its safety and efficacy.
METHODS
We collected the relevant data of 77 patients who underwent TLTG at the Fourth Hospital of Hebei Medical University from October 2021 to January 2023. Among them, 35 cases were treated with DTR, and the remaining 42 cases were treated with traditional RY. After 1:1 propensity score matching, the cases were grouped into 31 cases per group, with evenly distributed data. The clinical characteristics and short- and long-term clinical outcomes of the two groups were statistically analyzed.
RESULTS
The two groups showed no significant differences in basic data, intraoperative blood loss, number of lymph node dissections, first defecation time after operation, postoperative hospital stay, postoperative complications, and laboratory examination results on the 1st, 3rd, and 5th days after operation. The operation time of the DTR group was longer than that of the RY group [(307.58 ± 65.14) min vs (272.45 ± 62.09) min, P = 0.016], but the first intake of liquid food in the DTR group was shorter than that in the RY group [(4.45 ± 1.18) d vs (6.0 ± 5.18) d, P = 0.028]. The incidence of reflux heartburn (Visick grade) and postoperative gallbladder disease in the DTR group was lower than that in the RY group (P = 0.033 and P = 0.038). Although there was no significant difference in body weight, hemoglobin, prealbumin, and albumin between the two groups at 1,3 and 6 months after surgery, the diet of patients in the DTR group was better than that in the RY group (P = 0.031).
CONCLUSION
The clinical effect of DTR in TLTG is better than that of RY, indicating that it is a more valuable digestive tract reconstruction method in laparoscopic gastric cancer surgery.
Core Tip: We statistically analyzed the clinical results of patients with gastric cancer who underwent jejunal interposition double-tract reconstruction (DTR) and esophageal jejunum Roux-en-Y reconstruction (RY). Finally, it was found that compared to RY, DTR can improve postoperative life treatment, improve postoperative nutritional status, and reduce the incidence of gallbladder disease. It can also provide a duodenal pathway for endoscopic retrograde cholangio pancreatography, representing a better digestive tract reconstruction method than traditional Roux-en-Y esophagojejunostomy.
