Objective
To compare short-term effects of totally laparoscopic total gastrectomy (TLTG) and laparoscopic assisted total gastrectomy (TATG) in treatment of resectable gastric cancer.
Methods
The EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI, and WanFang Data databases were searched by computer. According to the inclusion and exclusion criteria of the literatures, the comparative research literatures were selected. The relevant data were extracted and the literature evaluation was applied. The Revman 5.3 software was applied for the meta-analysis.
Results
A total of 11 articles (6 Chinese literatures, 5 English literatures) were included, including 1 491 patients clinically diagnosed with the gastric cancer. The results of meta-analysis showed: compared with the LATG group, the TLTG group had the less intraoperative blood loss ［MD=–17.59, 95% CI (–30.81, –4.37), P=0.009］, shorter incision length ［MD=–4.50, 95% CI (–4.92, –4.09), P<0.000 01］, and earlier first anal exhaust time ［MD=–0.16, 95% CI (–0.28, –0.04), P=0.007］in the treatment of gastric cancer; Besides, the first time of postoperative fluid intake of the TLTG group was earlier ［MD=–0.47, 95% CI (–0.86, –0.08), P=0.02］ and the postoperative hospital stay of the TLTG group was shorter ［MD=–0.59, 95% CI (–0.94, –0.24), P=0.000 9］; In the TLTG group, the VAS score was lower on the first postoperative day ［MD=–3.10, 95% CI (–3.48, –2.72), P<0.000 01］ and on the third postoperative day ［MD=–2.30, 95% CI (–2.57, –2.03), P<0.000 01］. There were no significant differences in the operation time, proximal margin distance, distal margin distance, lymph node dissection, and postoperative adverse reactions between the two groups (P>0.05). The subgroup analysis of the postoperative adverse reactions showed that there were no significant differences in the anastomotic stricture, anastomotic leakage, and anastomotic bleeding (P>0.05).
Conclusions
TLTG has some advantages of less bleeding, shorter incision, earlier ventilation and feeding, shorter postoperative hospital stay, and light postoperative pain in treatment of resectable gastric cancer. However, due to quantitative and qualitative limitations of included studies, above conclusions still need to be carried out more and high quality researches are validated.
Objective To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction （AEG） and upper-middle gastric cancer. Methods Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of arch-preserved jejunum to resolve the anastomosis tension problem in our hospital from Dec. 2012 to Apr. 2013 were analyzedretrospectively， and surgical experience was summarized. Results The maximal and actual extended lengths were （7.75±1.75） cm （4-10 cm） and （5.95±1.82） cm （3-9 cm） respectively， with the utilization percentage of （77.91±16.60）% （50.0%-100.0%）. These patients hadn’t suffered postoperative mortality and severe complications， such as anastomosis leakage， stenosis， hemorrhage， and so on. Besides， there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection. Conclusion Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.
ObjectiveTo investigate the application value of bidirectional sutured esophagojejunal Overlap anastomosis in totally laparoscopic total gastrectomy (TLTG). MethodsA retrospective analysis was performed on 128 patients with gastric cancer who underwent TLTG in the Department of General Surgery, The Third People’s Hospital of Chengdu/Clinical College of Southwest Jiaotong University·The Affiliated Hospital of Southwest Jiaotong University from December 2020 to December 2023. Patients in the observation group underwent bidirectional sutured esophagojejunal Overlap anastomosis, while patients in the control group received conventional Overlap side-to-side esophagojejunostomy. The two groups were then compared based on clinical outcome measures. ResultsA total of 128 patients were included, including 80 in the observation group and 48 in the control group. The intraoperative anastomosis time [(25.75±5.78) min vs (29.43±2.73) min, P＜0.001], operative time [(244.81±39.16) min vs (257.18±44.36) min, P=0.037], time to postoperative flatus [(2.30±0.80) d vs (2.85±1.33) d, P=0.004], and postoperative hospital stay [(7.15±2.10) d vs (9.00±2.66) d, P＜0.001] of the observation group were shorter than those in the control group. In the observation group, anastomotic leakage occurred in one patient (Clavien-Dindo grade Ⅱ), who improved with conservative treatment and was discharged. All patients were successfully followed up after surgery, and the median follow-up time was 12 months. During follow-up, four deaths occurred (two in the observation group and two in the control group), all non-cancer-related. No other complications, recurrences, or metastases were observed. ConclusionBidirectional sutured esophagojejunal Overlap anastomosis is safe and feasible in TLTG, providing favorable short-term effects.
The substitution of ρ-shaped jejunum for stomach in 64 patients with gastric carcinoma after total gastrectomy is reported . Survival rate of the first, third anad fifth year afer surgery were 71.8%,42.2% and 34.4% respectively.Postoperative death and complications with fistula of anastomotic stoma , refulx esophagitis and dumping syndrome were not encountered in this all series. These results show that the operative procedure is a simple, safe, and can be accomplished within short time and that the quality of living of the patient is good.
Objective To investigate for a reasonable reconstruction method in patients undergoing total gastrectomy. Methods Data of 63 cases receiving total gastrectomy from January 2000 to October 2005 in Ganzhou District Hospital of Zhangye City were analyzed retrospectively, and the patients were divided into double pouch jejunum interposition （DPJI） group (n=30) and Roux-en-Y ρ pouch （RYρ） group (n=33) according to the operation methods, then operation time， morbidity of complications, amount and frequency of meat and drink, complications of digestive tract, amount of total protein and albumin were compared between two groups. Results There were no significant differences in operation time，morbidity of complications, the amount or frequency of meat and drink between two groups (Pgt;0.05); but the incidence of digestive tract complications of DPJI group was lower than that of RYρ group （P＜0.05). GradeⅠ/Ⅱof Vervaeck index and the amount of total protein and albumin in DPJI group were statistical significantly higher than those of RYρ group （P＜0.05）. Conclusion Functional DPJI is a reasonable digestive tract reconstruction method.
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.
Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenumjejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.
