Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1354
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
Gastric cancer is the fifth most common and third deadliest cancer worldwide. Surgical resection of gastric cancer depends on the stage at which the disease is diagnosed, extent to which the stomach area is involved, and whether the cancer has spread to nearby lymph nodes or distant organs. Therefore, the best reconstruction method and the optimal stapler for gastric cancer need to be explored further.
Current research has demonstrated that mechanical anastomoses in reconstructive surgery facilitate shorter operative time and reduce the risk of postoperative syndromes. Exploring the optimal stapler and digestive tract reconstruction method for gastric cancer will benefit patients.
To explore the efficacy of different staplers and digestive tract reconstruction method in radical gastrectomy for distal gastric cancer and their influence on prognosis.
Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer were included in the study and assigned to four groups based on the stapler and digestive tract reconstruction plan: 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 were compared among the four groups.
No significant differences in the maximum diameter of the gastric tumors, total number of lymph nodes dissected, drainage tube removal time, QLQ-C30 and QLQ-STO22 scores at 1 year postoperatively, and incidence of complications were observed among the four groups. 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 exhaustion time, and length of postoperative hospital stay than groups B and D (circular stapler).
Both linear and circular staplers are safe and feasible for use in digestive tract reconstruction; however, linear staplers have greater advantages in terms of postoperative recovery. B-I and B-II had similar effects on patients' quality of life postoperatively.
A recent study has demonstrated that the laparoscopic approach is a better option than open surgery in terms of the quality of life in the immediate postoperative period. However, the application of linear or circular staplers depends on many factors, such as cancer stage, extent of involvement of the stomach area, and spread of cancer. Further research is necessary to determine the best reconstruction method and the optimal stapler for gastric cancer.