Retrospective Study
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World J Gastrointest Surg. Sep 27, 2023; 15(9): 2003-2011
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2003
Multifactor analysis of the technique in total laparoscopic gastric cancer
Jia-Kun Shi, Bo Wang, Xin-Sheng Zhang, Pin Lv, Yun-Long Chen, Shuang-Yi Ren
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
ARTICLE HIGHLIGHTS
Research background

Esophageal gastric anastomosis is a common surgical technique used in the treatment of gastric cancer patients undergoing total gastrectomy. However, complications such as anastomotic stenosis and ulceration can arise when simple anastomosis techniques are used alone, which may not adequately meet patient needs. To address these issues and improve patient prognosis, the muscle flap reconstruction technique has emerged. Muscle flap reconstruction involves transplanting muscle tissue to enhance gastric-esophageal anastomosis. By covering the anastomotic site with muscle tissue, it not only improves stability but also enhances blood supply, promoting healing and recovery. Therefore, the application of muscle flap reconstruction in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widespread.

Research motivation

Gastric cancer is a significant health concern, and total gastrectomy is a common surgical treatment for this condition. However, traditional esophagogastric anastomosis techniques have limitations, leading to complications and suboptimal patient outcomes. The emergence of muscle flap reconstruction technique provides a potential solution to overcome these challenges. By transplanting muscle tissue, the technique improves the stability and blood supply of the anastomosis site, promoting healing and recovery.

Research objectives

The objective of this study was to evaluate the effect of esophagogastrostomy with muscle flap reconstruction technique on the prognosis of patients undergoing total gastrectomy for gastric cancer.

Research methods

This study included 60 patients with gastric cancer who underwent total abdominal gastrectomy with esophagogastric anastomosis using double muscle flap reconstruction technique. Perioperative indicators, such as operation time, formation time of esophageal double muscle flap anastomosis, number of lymph node dissections, incision length, intraoperative bleeding volume, were recorded. Patients were followed up for one year to observe outcomes and classify patients based on different outcomes. Clinicopathological parameters were analyzed to identify factors affecting patient prognosis.

Research results

The study involved 60 patients with gastric cancer who underwent total abdominal gastrectomy with esophagogastric anastomosis using double muscle flap reconstruction technique. The operation time averaged (318 ± 43 min), formation time of esophageal double muscle flap anastomosis was (110 ± 13 min), and other perioperative indicators were measured. Three postoperative complications were recorded: 2 cases of pulmonary infection and 1 case of respiratory discomfort. During the one-year follow-up, 50 patients survived while 10 died. Univariate analysis identified histological types, tumor size, tumor-node-metastasis staging, vascular invasion, and postoperative adjuvant radiotherapy and chemotherapy as the main factors affecting prognosis in surviving patients. Cox regression analysis confirmed the significance of postoperative adjuvant therapy on patient prognosis. The survival time of the survival group was significantly higher than that of the death group (P < 0.05).

Research conclusions

The study concludes that esophagogastric anastomosis with muscle flap reconstruction is effective for patients undergoing total abdominal gastrectomy for gastric cancer. The technique improves the stability of the anastomosis site and enhances blood supply, promoting healing and recovery. Esophagogastric anastomosis with muscle flap reconstruction technique shows positive outcomes in patients undergoing total abdominal gastrectomy for gastric cancer, and postoperative adjuvant therapy plays a vital role in improving patient prognosis.

Research perspectives

Future research can focus on optimizing the muscle flap reconstruction technique to further enhance surgical outcomes and minimize complications. Additionally, investigating the long-term effects of postoperative adjuvant radiotherapy and chemotherapy on patient prognosis would provide valuable insights. Furthermore, evaluating the cost-effectiveness of this technique and comparing it with other surgical methods will help guide decision-making in clinical practice.