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Fu Y, Ren J, Ma Y, Zhou J, Shao W, Sun G, Sun Q, Wang D. Analysis of Clinical Efficacy and Quality of Life of Braun Anastomosis in Gastrointestinal Reconstruction in Totally Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study. J Gastrointest Cancer 2024; 55:1256-1265. [PMID: 38913210 DOI: 10.1007/s12029-024-01079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE This study aimed to compare the clinical efficacy and quality of life of B-IIB (Billroth-II with Braun anastomosis) and B-II (Billroth-II anastomosis) in the alimentary tract reconstruction postoperative totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. METHODS From February 2016 to January 2022, 158 patients underwent totally laparoscopic distal gastrectomy and D2 lymphadenectomy in Northern Jiangsu People's Hospital, with Billroth-II with Braun anastomosis for 93 patients and Billroth-II anastomosis for 65 patients. The patients' data were collected prospectively and reviewed retrospectively. RESULTS In this study, the post-op hospital stay of B-IIB group were shorter than B-II group (12.70 ± 3.08 days in the B-IIB group versus 14.12 ± 4.90 days in the B-II group, p < 0.05) and the first post-op flatus time of the B-IIB group were shorter than B-II group (3.49 ± 1.02 days versus 4.08 ± 1.85 days, p < 0.05). Two groups did differ significantly in hemoglobin on postoperative 3 months, albumin at 3 months after operation, and serum sodium on postoperative 3 days and 3 months (p < 0.05), and the B-IIB had an advantage; the complications incidence (Clavien-Dindo grade II or even a higher grade) of the B-IIB group and B-II group were 10.75% and 29.23%, respectively. There being a statistical difference between the two groups. The B-IIB group and the B-II group both had different degrees of weight loss at 3 months after operation compared with preoperative weight. The weight of B-IIB group was 4.04 ± 1.33 kg, which was less than B-II group (8.08 ± 1.47 kg). The difference was statistically significant (p < 0.05). According to the PGSAS (Postgastrectomy Syndrome Assessment Scale), the score of the B-IIB group is lower than that of the B-II group for esophageal reflux gastritis, dyspepsia, and dumping syndrome group (1.84 ± 0.92 VS 2.15 ± 0.85, P = 0.031; 1.86 ± 1.10 VS 2.22 ± 0.91, P = 0.034; 1.98 ± 1.06 VS 2.32 ± 0.94, P = 0.037, respectively). CONCLUSION Totally laparoscopic distal gastrectomy with Billroth-II Braun reconstruction is a safe and technically feasible method for gastric cancer patients, which can reduce the incidence of postoperative reflux esophagitis and dumping syndrome. Compared with Billroth-II reconstruction, it has advantages in maintaining postoperative nutritional status and electrolyte balance and improving quality of life.
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Affiliation(s)
- Yayan Fu
- Medical College of Yangzhou University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
| | - Jun Ren
- Medical College of Yangzhou University, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Yue Ma
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Northern Jiangsu People's Hospital Affiliated to Nanjing Medical University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- The Hanjiang District Maternal and Child Health Care Hospital, Yangzhou, 225100, Jiangsu, China
| | - Jiajie Zhou
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Medical School, Nanjing University, Nanjing, 211166, Jiangsu, China
| | - Wenzhe Shao
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Dalian Medical University, Dalian, 116044, China
| | - Guowei Sun
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
- Dalian Medical University, Dalian, 116044, China
| | - Qiannan Sun
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China
| | - Daorong Wang
- Medical College of Yangzhou University, Yangzhou, 225001, China.
- Northern Jiangsu People's Hospital Affiliated to Yangzhou University, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu, China.
- Yangzhou University, Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China.
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Zhao Z, Li H, Pan X, Shen C, Mu M, Yin X, Liao J, Cai Z, Zhang B. Optimal reconstruction methods after distal gastrectomy for gastric cancer: a protocol for a systematic review and network meta-analysis update. Syst Rev 2024; 13:19. [PMID: 38184617 PMCID: PMC10770945 DOI: 10.1186/s13643-023-02445-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 12/24/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Distal gastrectomy (DG) is a commonly used surgical procedure for gastric cancer (GC), with three reconstruction methods available: Billroth I, Billroth II, and Roux-en-Y. In 2018, our team published a systematic review to provide guidance for clinical practice on the optimal reconstruction method after DG for GC. However, since then, new evidence from several randomized controlled trials (RCTs) has emerged, prompting us to conduct an updated systematic review and network meta-analysis to provide the latest comparative estimates of the efficacy and safety of the three reconstruction methods after DG for GC. METHOD This systematic review and network meta-analysis update followed the PRISMA-P guidelines and will include a search of PubMed, Embase, and the Cochrane Library for RCTs comparing the outcomes of Billroth I, Billroth II, or Roux-en-Y reconstruction after DG for patients with GC. Two independent reviewers will screen the titles and abstracts based on predefined eligibility criteria, and two reviewers will assess the full texts of relevant studies. The Bayesian network meta-analysis will evaluate various outcomes, including quality of life after surgery, anastomotic leakage within 30 days after surgery, operation time, intraoperative blood loss, major postoperative complications within 30 days after surgery, incidence and severity of bile reflux, and loss of body weight from baseline. ETHICS AND DISSEMINATION The review does not require ethical approval. The findings of the review will be disseminated through publication in an academic journal, presentations at conferences, and various media outlets. INPLASY REGISTRATION NUMBER INPLASY2021100060.
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Affiliation(s)
- Zhou Zhao
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
- Department of Gastrointestinal Cancer Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Hancong Li
- Department of General Surgery, Division of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiangcheng Pan
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Mingchun Mu
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaonan Yin
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Jing Liao
- Department of General Surgery, Division of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhaolun Cai
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Bo Zhang
- Department of General Surgery, Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Chen YX, Huang QZ, Wang PC, Zhu YJ, Chen LQ, Wu CY, Wang JT, Chen JX, Ye K. Short- and long-term outcomes of Roux-en-Y and Billroth II with Braun reconstruction in total laparoscopic distal gastrectomy: a retrospective analysis. World J Surg Oncol 2023; 21:361. [PMID: 37990273 PMCID: PMC10664253 DOI: 10.1186/s12957-023-03249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has persisted. Recent studies have demonstrated their efficacy, but the long-term outcomes and postoperative quality of life (QoL) among patients have yet to be evaluated. Therefore, we compared the short-term and long-term outcomes of the two procedures as well as QoL. METHODS The clinical data of 151 patients who underwent total laparoscopic distal gastrectomy (TLDG) at the Gastrointestinal Surgery Department of the Second Hospital of Fujian Medical University from January 2016 to December 2019 were retrospectively analyzed. Of these, 57 cases with Roux-en-Y procedure (R-Y group) and 94 cases with Billroth II with Braun procedure were included (BII + B group). Operative and postoperative conditions, early and late complications, endoscopic outcomes at year 1 and year 3 after surgery, nutritional indicators, and quality of life scores at year 3 postoperatively were compared between the two groups. RESULTS The R-Y group recorded a significantly longer operative time (194.65 ± 21.52 vs. 183.88 ± 18.02 min) and anastomotic time (36.96 ± 2.43 vs. 27.97 ± 3.74 min) compared to the BII + B group (p < 0.05). However, no other significant differences were observed in terms of perioperative variables, including blood loss (p > 0.05). Both groups showed comparable rates of early and late complications. Endoscopic findings indicated similar food residuals at years 1 and 3 post-surgery for both groups. The R-Y group had a lower occurrence of residual gastritis and bile reflux at year 1 and year 3 after surgery, with a statistically significant difference (p < 0.001). Reflux esophagitis was not significantly different between the R-Y and BII + B groups in year 1 after surgery (p = 0.820), but the R-Y group had a lower incidence than the BII + B group in year 3 after surgery (p = 0.023). Nutritional outcomes at 3 years after surgery did not differ significantly between the two groups (p > 0.05). Quality of life scores measured by the QLQ-C30 scale were not significantly different between the two groups. However, on the QLQ-STO22 scale, the reflux score was significantly lower in the R-Y group than in the BII + B group (0 [0, 0] vs. 5.56 [0, 11.11]) (p = 0.003). The rest of the scores were not significantly different (p > 0.05). CONCLUSION Both R-Y and B II + B reconstructions are equally safe and efficient for TLDG. Nevertheless, the R-Y reconstruction reduces the incidence of residual gastritis, bile reflux, and reflux esophagitis, as well as postoperative reflux symptoms, and provides a better quality of life for patients. R-Y reconstruction is superior to BII + B reconstruction for TLDG.
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Affiliation(s)
- Yan-Xin Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Qiao-Zhen Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Peng-Cheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yue-Jia Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Li-Quan Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jin-Tian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jun-Xing Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China.
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Tokuhara T, Nakata E, Ogata A, Tenjo T, Kawai I, Kondo K, Hatabe S, Yokoyama K. Intracorporeal gastrojejunostomy in Roux-en-Y reconstruction with its efferent loop located on the patient's left side following totally laparoscopic distal gastrectomy: A case report. Mol Clin Oncol 2022; 16:47. [PMID: 35003745 PMCID: PMC8739077 DOI: 10.3892/mco.2021.2480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/08/2021] [Indexed: 12/02/2022] Open
Abstract
The drawback of intracorporeal gastrojejunostomy using only endoscopic linear staplers in antecolic Roux-en-Y (R-Y) reconstruction with its efferent loop located on the patient's left side following totally laparoscopic distal gastrectomy (TLDG) is the occurrence of anastomotic failure, even though this reconstruction system is assumed to prevent intraoperative and postoperative twisting of the gastrojejunostomy and lifted jejunum. This case report presents two patients with gastric cancer who underwent intracorporeal gastrojejunostomy consisting of linear stapling and hand suturing in antecolic R-Y reconstruction with its efferent loop located on the patient's left side following TLDG to prevent anastomotic failure of the gastrojejunostomy. After the sacrificed jejunum was created, linear stapling of the greater curvature of the remnant stomach and the lifted jejunum without dividing the jejunum was performed. After removing the sacrificed jejunum and creating a good view of the posterior side of the stapler entry hole, the stapler entry hole was closed from the posterior side to the anterior side, using a single-layer full-thickness and serosubmucosal hand suturing technique with knotted sutures and a knotless barbed suture. No anastomotic failure of the gastrojejunostomy occurred in either patient. Intracorporeal gastrojejunostomy consisting of linear stapling and hand suturing could be an option for gastrojejunostomy in antecolic R-Y reconstruction with its efferent loop located on the patient's left side following TLDG because it can aid in the prevention of anastomotic failure.
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Affiliation(s)
- Takaya Tokuhara
- Department of Surgery, Tanigawa Memorial Hospital, Osaka 567-0031, Japan.,Department of Surgery, Otori Stomach and Intestines Hospital, Osaka 593-8311, Japan
| | - Eiji Nakata
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka 593-8311, Japan
| | - Akihito Ogata
- Department of Surgery, Tanigawa Memorial Hospital, Osaka 567-0031, Japan
| | - Toshiyuki Tenjo
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka 593-8311, Japan
| | - Isao Kawai
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka 593-8311, Japan
| | - Keisaku Kondo
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka 593-8311, Japan
| | - Shigeru Hatabe
- Department of Surgery, Otori Stomach and Intestines Hospital, Osaka 593-8311, Japan
| | - Kazutake Yokoyama
- Department of Surgery, Tanigawa Memorial Hospital, Osaka 567-0031, Japan
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Yalikun A, Aikemu B, Li S, Zhang T, Ma J, Zheng M, Zang L. A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy: Initial Experience Compared with Roux-en-Y Anastomosis. Ann Surg Oncol 2022; 29:2359-2367. [PMID: 34994886 DOI: 10.1245/s10434-021-11187-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND This retrospective study aimed to compare the feasibility and effectiveness of a modified Billroth-II with Braun (B-II Braun) reconstruction and those of a Roux-en-Y (R-Y) reconstruction after laparoscopic distal gastrectomy. METHODS From January 2016 to December 2019, 247 patients underwent total laparoscopic distal gastrectomy (TLDG), with B-II Braun reconstruction for 145 patients and R-Y reconstruction for 102 patients. The patients' data were collected prospectively and reviewed retrospectively. RESULTS In this study, the median times of the operation were statistically shorter for B-II Braun than for R-Y (167 min [range, 110-331 min] vs 191 min [range, 123-384 min]; p = 0.001), including anastomotic times (33 min [range, 30-42 min] vs 42 min [range, 40-48 min]; p = 0.001). After a short-term follow-up period, endoscopy showed 31 cases of bile reflux (21.4%), 15 cases of grade 2 gastritis (10.3%), and 6 cases of grade 2 food residue (4.1%) in the B-II Braun group after 6 months. After 1 year, 10 patients (6.9%) had grade 2 gastritis and 2 patients (1.4%) had grade 3 gastritis. However, the remnant stomach of the two groups did not differ significantly in the rate of gastric residue (p = 0.112 after 6 months; p = 0.579 after 1 year, respectively), gastritis (p = 0.726 after 6 months; p = 0.261 after 1 year, respectively), or bile reflux (p = 0.262 after 6 months; p = 0.349 after 1 year, respectively). CONCLUSIONS For gastric cancer patients, TLDG with modified B-II Braun reconstruction could be technically feasible. It has an acceptable range of postoperative complications and is effective in preventing bile reflux into the gastric remnant.
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Affiliation(s)
- Abudushalamu Yalikun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Batuer Aikemu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Shuchun Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
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Billroth-II with Braun versus Roux-en-Y reconstruction in totally laparoscopic distal gastrectomy for gastric cancer. Wideochir Inne Tech Maloinwazyjne 2021; 16:664-668. [PMID: 34950260 PMCID: PMC8669982 DOI: 10.5114/wiitm.2021.103965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/16/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Totally laparoscopic distal gastrectomy (TLDG) has been increasingly adopted for the treatment of gastric cancer. Both Billroth-II with Braun (B-IIB) reconstruction and Roux-en-Y (R-Y) reconstruction are commonly performed in TLDG; however, which of these reconstruction techniques is better remains unclear. Aim To compare the efficacy of B-IIB reconstruction and R-Y reconstruction in TLDG for gastric cancer. Material and methods A total of 105 gastric cancer patients who underwent TLDG with B-IIB or R-Y reconstruction were reviewed from January 2019 to July 2020. Clinicopathological characteristics and perioperative data of the B-IIB and R-Y groups were compared. Results Clinicopathological characteristics were not significantly different between the B-IIB and R-Y groups. The average total operative time for the R-Y group (161.9 ±20.7 min) was significantly longer than that for the B-IIB group (141.9 ±16.7 min). The average anastomosis time for the R-Y group (25.5 ±4.1 min) was also significantly longer than that for the B-IIB group (18.9 ±3.3 min). Blood loss volume, number of retrieved lymph nodes, time to first flatus, average length of postoperative hospital stay, inflammatory parameters and postoperative complications did not differ between the two groups. Conclusions Both B-IIB reconstruction and R-Y reconstruction are safe and effective in TLDG. B-IIB reconstruction is easier and faster to perform than R-Y reconstruction in TLDG.
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Wu CH, Huang KH, Chen MH, Fang WL, Chao Y, Lo SS, Li AFY, Wu CW, Shyr YM. Comparison of the Long-term Outcome Between Billroth-I and Roux-en-Y Reconstruction Following Distal Gastrectomy for Gastric Cancer. J Gastrointest Surg 2021; 25:1955-1961. [PMID: 33205309 DOI: 10.1007/s11605-020-04867-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Various reconstruction methods have been performed following distal gastrectomy; however, each reconstruction method has its own advantages and disadvantages. This study aims to compare the long-term outcomes between Billroth-I (B-I) and Roux-en-Y (RY) reconstruction after distal gastrectomy for gastric cancer. METHODS A total of 459 patients who underwent distal gastrectomy (B-I: 166, RY: 293) were included. Postoperative endoscopic findings and biliary tract stone formation were compared between the two groups. RESULTS At 1 year and 2 years postoperatively, gastric residue was more common in the RY group, gastritis was similar between groups, and bile reflux was more common in the B-I group. At 5 years postoperatively, gastric residue was similar between the groups, while gastritis and bile reflux were more common in the B-I group. Gastroesophageal reflux was more common in the B-I group at 1 year postoperatively, but gastroesophageal reflux became not significantly different between the groups at 2 and 5 years postoperatively. Gallstone formation was more common in the RY group and in patients aged ≥ 65 years. CONCLUSION During long-term follow-up, RY reconstruction was associated with lower incidence of bile reflux and gastritis, and higher incidence of gallstone formation than B-I reconstruction. The incidence of gastric residue was more common in the RY reconstruction group in the early postoperative period and became not significantly different between the two groups over time. For aged patients with RY reconstruction, cholecystectomy is recommended concurrently as gastrectomy.
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Affiliation(s)
- Chia-Hung Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Hung Huang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Huang Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Liang Fang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yee Chao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Su-Shun Lo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,National Yang-Ming University Hospital, Yilan, Taiwan
| | - Anna Fen-Yau Li
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chew-Wun Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Jiang H, Li Y, Wang T. Comparison of Billroth I, Billroth II, and Roux-en-Y reconstructions following distal gastrectomy: A systematic review and network meta-analysis. Cir Esp 2021; 99:412-420. [PMID: 34130813 DOI: 10.1016/j.cireng.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023]
Abstract
Major surgical treatment for distal gastric cancer include Billroth I (BI), Billroth II (BII), and Roux-en-Y (RY). Since the optimal reconstruction methods remains inconclusive, we aimed to compare these treatments in terms of intraoperative and postoperative course after distal gastrectomy with a systematic review and random-effects network meta-analysis. We searched PubMed, Web of Knowledge, Ovid's database for prospective, randomized, controlled trials comparing the outcomes of BI, BII, and RY reconstruction after distal gastrectomy until January 2020. From the included studies, operative time, intraoperative blood loss, postoperative hospital stay, endoscopic findings and complications were extracted as the short- and long-term outcomes of reconstructions. The network meta-analysis was performed with R 3.5.2 software as well as "gemtc" and "forestplot" packages. Twelve randomized controlled trials (RCTs) involving 1662 patients were included. RY reconstruction has a lower risk and degree of remnant gastritis than BI and BII reconstructions(OR 0.40, 95%Crl: 0.24-0.64; OR 0.36, 95% Crl: 0.16-0.83, respectively). BI reconstruction method took significantly less time to perform as compared to BII and RY reconstruction (WMD 20, 95% Crl: 0.18-41; WMD 30, 95% Crl: 14-25, respectively). No differences in intraoperative blood loss, time to resumed oral intake, postoperative hospital stay, reflux oesophagitis and complications among the three reconstructions. The RY reconstruction after distal gastrectomy was more effective in preventing remnant gastritis than Billroth I and Billroth II reconstruction, although RY reconstruction was considered as technical complexity.
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Affiliation(s)
- Haitao Jiang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
| | - Yujie Li
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China.
| | - Tianfei Wang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
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9
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Bile reflux after one anastomosis gastric bypass surgery: A review study. Ann Med Surg (Lond) 2021; 64:102248. [PMID: 33868682 PMCID: PMC8040101 DOI: 10.1016/j.amsu.2021.102248] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/11/2022] Open
Abstract
Background Recently the performance rate of one anastomosis gastric bypass (OAGB) bariatric surgery has increased. Bile reflux is on of common considered complication of OAGB challenging surgeon. Methods We searched English full text with keyword "bile reflux" AND "OAGB" OR "one anastomosis gastric bypass" OR "SAGB" OR "single anastomosis gastric bypass" that published from January 1st, 2000 to December 31st, 2020 in PubMed, EMBASE, Google scholar and Cochrane Library. We included prospective or retrospective systematic review, review, clinical, and meta-analysis human article that its full text was available and focused on bile reflux after OAGB/SAGB as the fundamental performed bariatric surgery. Results A total of 1259 articles were analyzed, of which 5 were included. Analysis of number articles by year revealed that 2019 and 2020 was the highest number of published articles (n = 232; 68%). Study type analysis revealed that review studies and clinical research (n = 62; 18.2%) were the most frequent study types. Reported data on bile reflux after OAGB had diversity. Implicitly, postoperative incidence of bile reflux differed from 7.8 to 55.5%. General consensus was not existed among authors to consider the OAGB as the first suspect leading to postoperative bile reflux among other bariatric surgery types. Conclusion Although surgeons prefer to conduct OAGB procedure because of its easier surgical approach needing just one anastomosis formation it is not virtually clear that is the procedure costly benefitted regarding bile reflux outcomes.
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Jiang H, Li Y, Wang T. Comparison of Billroth I, Billroth II, and Roux-en-Y reconstructions following distal gastrectomy: A systematic review and network meta-analysis. Cir Esp 2020. [PMID: 33092808 DOI: 10.1016/j.ciresp.2020.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Major surgical treatment for distal gastric cancer include Billroth I (BI), Billroth II (BII), and Roux-en-Y (RY). Since the optimal reconstruction methods remains inconclusive, we aimed to compare these treatments in terms of intraoperative and postoperative course after distal gastrectomy with a systematic review and random-effects network meta-analysis. We searched PubMed, Web of Knowledge, Ovid's database for prospective, randomized, controlled trials comparing the outcomes of BI, BII, and RY reconstruction after distal gastrectomy until January 2020. From the included studies, operative time, intraoperative blood loss, postoperative hospital stay, endoscopic findings and complications were extracted as the short- and long-term outcomes of reconstructions. The network meta-analysis was performed with R 3.5.2 software as well as "gemtc" and "forestplot" packages. Twelve randomized controlled trials (RCTs) involving 1662 patients were included. RY reconstruction has a lower risk and degree of remnant gastritis than BI and BII reconstructions(OR 0.40, 95%Crl: 0.24-0.64; OR 0.36, 95% Crl: 0.16-0.83, respectively). BI reconstruction method took significantly less time to perform as compared to BII and RY reconstruction (WMD 20, 95% Crl: 0.18-41; WMD 30, 95% Crl: 14-25, respectively). No differences in intraoperative blood loss, time to resumed oral intake, postoperative hospital stay, reflux oesophagitis and complications among the three reconstructions. The RY reconstruction after distal gastrectomy was more effective in preventing remnant gastritis than Billroth I and Billroth II reconstruction, although RY reconstruction was considered as technical complexity.
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Affiliation(s)
- Haitao Jiang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
| | - Yujie Li
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China.
| | - Tianfei Wang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
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11
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Zhou W, Dong CZ, Zang YF, Xue Y, Zhou XG, Wang Y, Ding YL. Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction. World J Gastroenterol 2020; 26:4669-4679. [PMID: 32884224 PMCID: PMC7445872 DOI: 10.3748/wjg.v26.i31.4669] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Single incision plus one port left-side approach (SILS+1/L) totally laparoscopic distal gastrectomy (TLDG) is an emerging technique for the treatment of gastric cancer. Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy: relieving postoperative pain, shortening hospital stay and offering a better cosmetic outcome. Nevertheless, there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y (uncut R-Y) reconstruction.
AIM To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction (uncut R-Y reconstruction) to treat distal gastric cancer.
METHODS A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at The Second Hospital of Shandong University. Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler. The clinicopathological characteristics, surgical details, postoperative short-term outcomes, postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.
RESULTS All SILS+1/L operations were performed by SILS+1/L TLDG successfully. The patient population included 13 men and 8 women with a mean age of 48.2 years (ranged from 40 years to 70 years) and median body mass index of 22.8 kg/m2. There were no conversions to open laparotomy, and no other port was placed. The mean operation time was 146 min (ranged 130-180 min), and the estimated mean blood loss was 54 mL (ranged 20-110 mL). The mean duration to flatus and discharge was 2.3 (ranged 1-3.5) and 7.3 (ranged 6-9) d, respectively. The mean number of retrieved lymph nodes was 42 (ranged 30-47). Two patients experienced mild postoperative complications, including surgical site infection (wound at the navel incision) and mild postoperative pancreatic fistula (grade A). Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively. No patients experienced moderate or severe food stasis, alkaline gastritis or bile reflux during the follow-up period. No recanalization of the biliopancreatic limb was found.
CONCLUSION SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.
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Affiliation(s)
- Wei Zhou
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Chang-Zheng Dong
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yi-Feng Zang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Ying Xue
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Xing-Guo Zhou
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yu Wang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yin-Lu Ding
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
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12
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Wang J, Wang Q, Dong J, Yang K, Ji S, Fan Y, Wang C, Ma Q, Wei Q, Ji G. Total Laparoscopic Uncut Roux-en-Y for Radical Distal Gastrectomy: An Interim Analysis of a Randomized, Controlled, Clinical Trial. Ann Surg Oncol 2020; 28:90-96. [PMID: 32556870 DOI: 10.1245/s10434-020-08710-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The traditional Billroth II and Roux-en-Y anastomosis after laparoscopic distal gastrectomy for gastric cancer are associated with bile reflux gastritis and roux stasis syndrome, respectively. The uncut Roux-en-Y gastrojejunostomy can decrease the incidence of these complications by blocking the entry of bile and pancreatic juice into the residual stomach and retaining the impulses originating from the duodenum. The purpose of the present study was to compare the short-term outcomes of uncut Roux-en-Y (URY) and Billroth II combined Braun (BB) anastomosis. METHODS In this prospective, multi-center, two-arm randomized controlled trial, 124 patients with advanced distal gastric cancer were randomized into two groups: URY (n = 62) and BB (n = 62) groups. RESULTS The mean gastric juice pH was significantly lower in the URY group compared with the BB group (3.94 ± 0.71 vs. 5.83 ± 0.91, P < 0.0001). The bile reflux gastritis at 3 months (P < 0.0001) and 6 months (P = 0.002) was significantly more frequent in the BB group. No recanalization occurred in the URY group, and no significant difference was found between the two groups in terms of mean operative time (P = 0.69), mean time to perform anastomosis (P = 0.86), mean estimated blood loss (P = 0.77), mean number of harvested lymph nodes (P = 0.90), time to first passage of flatus or defecation (P = 0.87), postoperative hospital stay (P = 0.83), and the incidence of postoperative complications (P = 0.70). CONCLUSIONS URY anastomosis is associated with a significantly lower incidence of bile reflux gastritis and roux stasis syndrome compared with BB anastomosis.
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Quan Wang
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China
| | - Junqiang Dong
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Kelu Yang
- Evidence-Based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, China
| | - Sheqing Ji
- Henan Cancer Hospital and Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Yong Fan
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Chen Wang
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Qi Ma
- Henan Cancer Hospital and Zhengzhou University Cancer Hospital, Zhengzhou University, Zhengzhou, China
| | - Qiuya Wei
- Department of Minimally Invasive Surgery, the Second Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Gang Ji
- Department of Digestive Surgery, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, China.
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13
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Ma Y, Li F, Zhou X, Wang B, Lu S, Wang W, Yu S, Fu W. Four reconstruction methods after laparoscopic distal gastrectomy: A systematic review and network meta-analysis. Medicine (Baltimore) 2019; 98:e18381. [PMID: 31860999 PMCID: PMC6940138 DOI: 10.1097/md.0000000000018381] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is no consensus regarding which reconstruction methods are superior after laparoscopic distal gastrectomy (LDG). This study compared four reconstruction methods after LDG for gastric cancer. METHODS Literature in EMBASE, PubMed, and the Cochrane Library was screened to compare Billroth I (B-I), Billroth II (B-II), Roux-en-Y (RY), and uncut Roux-en-Y (URY) anastomoses after LDG for gastric cancer. A Bayesian network meta-analysis (NMA) was conducted to compare these methods. RESULTS Eighteen studies involving 4347 patients were eligible for our NMA. The operative time in RY anastomosis was longer than that in B-I and B-II anastomoses. Blood loss and risk of gastrointestinal motility dysfunction were greater with RY anastomosis than with URY or B-I anastomosis. Furthermore, URY anastomosis was superior to the other 3 reconstruction methods for preventing food residue. For remnant gastritis, RY anastomosis was significantly superior to B-I and B-II anastomoses, whereas URY anastomosis was significantly superior to B-II anastomosis. In addition, RY and URY anastomoses were better than B-I and B-II anastomoses for preventing bile reflux. CONCLUSIONS URY anastomosis tended to be a more favorable reconstruction method after LDG due to its operative simplicity and reduced long-term complications.
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14
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Park YE, Kim SW. Clinicopathologic features of remnant gastric cancer after curative distal gastrectomy according to previous reconstruction method: a retrospective cohort study. World J Surg Oncol 2019; 17:203. [PMID: 31785616 PMCID: PMC6885312 DOI: 10.1186/s12957-019-1740-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Survival rate of patients treated for gastric cancer has increased due to early detection and improvements of surgical technique and chemotherapy. Increase in survival rate has led to an increase in the risk for remnant gastric cancer (RGC). The purpose of this study was to investigate clinicopathologic features of RGC according to previous reconstruction method and factors affecting the interval from previous curative distal gastrectomy for gastric cancer to RGC occurrence. METHODS Medical records of patients diagnosed with RGC at Yeungnam University Medical Center from January 2000 to December 2017 who had a history of distal gastrectomy with D2 LN dissection due to gastric cancer were reviewed retrospectively. RESULTS Forty-eight patients were enrolled in this study. The mean interval of 48 RGC patients was 105.6 months (8.8 years). RGC after Billroth II reconstruction recurred more often at anastomosis site than RGC after Billroth I reconstruction (p = 0.001). The mean interval of RGC after Billroth I reconstruction was 67 months, shorter than 119 months of RGC after Billroth II reconstruction (p = 0.003). On the contrary, interval showed no difference according to stage of previous gastric cancer, remnant gastric cancer, or sex (p = 0.810, 0.145, and 0.372, respectively). CONCLUSIONS RGC after Billroth I reconstruction tends to arise earlier at non-anastomosis site than RGC after Billroth II. Therefore, we should examine non-anastomosis site carefully from the beginning of surveillance after gastric cancer surgery with Billroth I reconstruction for better outcome.
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Affiliation(s)
- Yong-Eun Park
- Department of surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Sang-Woon Kim
- Department of surgery, Yeungnam University Medical Center, Daegu, Korea.
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15
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Ren Z, Wang WX. Comparison of Billroth I, Billroth II, and Roux-en-Y Reconstruction After Totally Laparoscopic Distal Gastrectomy: A Randomized Controlled Study. Adv Ther 2019; 36:2997-3006. [PMID: 31605307 DOI: 10.1007/s12325-019-01104-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aimed to explore the efficacy of delta-shaped Billroth I anastomosis in totally laparoscopic distal gastrectomy for digestive tract reconstruction, and provide clinical data for determining the most appropriate digestive tract reconstruction method after distal gastrectomy. METHODS This was a prospective randomized controlled study. A total of 180 patients were randomly and prospectively selected from Renmin Hospital of Wuhan University by random number table. These patients were randomly divided into three groups: Billroth I group, Billroth II group, and Roux-en-Y (RY) group. RESULTS There were significant differences in resection margin, blood nutrition, and the number of postoperative complications among these three groups (P < 0.05). Furthermore, the resection margin, blood nutrition status, and immunization of patients in these three groups were determined. Compared to the other groups, the RY group was better in terms of hematologic status, immunological index, and postoperative complications. CONCLUSION Delta-shaped Billroth I anastomosis in totally laparoscopic distal gastrectomy for digestive tract reconstruction is simple and easy to perform, and has an advantage in postoperative gastrointestinal function recovery. RY reconstruction is superior to Billroth I and Billroth II in terms of postoperative complications.
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16
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Revisiting Laparoscopic Reconstruction for Billroth 1 Versus Billroth 2 Versus Roux-en-Y After Distal Gastrectomy: A Systematic Review and Meta-Analysis in the Modern Era. World J Surg 2019; 43:1581-1593. [DOI: 10.1007/s00268-019-04943-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Chen XJ, Chen YZ, Chen DW, Chen YL, Xiang J, Lin YJ, Chen S, Peng JS. The Development and Future of Digestive Tract Reconstruction after Distal Gastrectomy: A Systemic Review and Meta-Analysis. J Cancer 2019; 10:789-798. [PMID: 30854084 PMCID: PMC6400796 DOI: 10.7150/jca.28843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y are common reconstruction techniques of distal gastrectomy. Which of these techniques is better has yet to be established. We performed an indirect comparison to evaluate which technique was optimal for preventing reflux symptoms. Methods: The PubMed, Cochrane Collaboration, Embase, ClinicalTrials.gov and Web of Science databases were searched to identify clinical trials that compared at least two of the reconstruction skills among Billroth I, Billroth II, Roux-en-Y, and Un-cut Roux-en-Y. Data on reflux gastritis, intraoperative blood loss, bile reflux and postoperative hospital stays were extracted from the included clinical trials for meta-analysis using a random-effects model. Results: Twenty-four articles that included 5419 individuals were assessed as eligible for meta-analysis. The indirect comparison suggested that Roux-en-Y reconstruction significantly reduces reflux gastritis, and it tended to rank first and had the highest probability of preventing bile reflux. No significant differences were found in intraoperative blood loss and postoperative hospital stays. Conclusion: This indirect comparison suggested some superiority of Roux-en-Y reconstruction after distal gastrectomy. Further perspective clinical trials are required to provide evidence for the optimal reconstruction skill.
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Affiliation(s)
- Xi-Jie Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Yun-Zhi Chen
- Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-Sen University, and Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, 510630, P. R. China
| | - Dong-Wen Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Ying-Liang Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Jun Xiang
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Yi-Jia Lin
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Shi Chen
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
| | - Jun-Sheng Peng
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510655, P. R. China.,Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, P. R. China
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Du J, Xue H, Hua J, Zhao L, Zhang Z. Intracorporeal classic circular-stapled gastrojejunostomy and jejunojejunostomy during laparoscopic distal gastrectomy: A simple, safe "intraluminal poke technique" for anvil placement. J Surg Oncol 2018; 119:464-471. [PMID: 30582618 DOI: 10.1002/jso.25353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/09/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Totally laparoscopic distal gastrectomy is being increasingly performed. However, an optimal procedure to achieve intracorporeal gastrojejunostomy and jejunojejunostomy for Roux-en-Y reconstruction after laparoscopic distal gastrectomy remains to be established. Compared with the simple and preferable circular-stapled Roux-en-Y reconstruction in open gastrectomy, application of intracorporeal circular-stapled gastrojejunostomy and jejunojejunostomy of Roux-en-Y reconstruction during laparoscopic distal gastrectomy have been limited (no report of intracorporeal circular-stapled jejunojejunostomy) because of the difficulties of intracorporeal purse-string suture and anvil placement. To address these problems, a simple and safe intraluminal poke technique of universal surgical concept and procedure was introduced and evaluated. METHODS Between March 2018 and August 2018, 24 consecutive patients with gastric cancer underwent totally laparoscopic distal gastrectomy in our hospital. Roux-en-Y reconstruction of intracorporeal circular-stapled gastrojejunostomy and jejunojejunostomy with the intraluminal poke technique was performed in all patients. Demographic and clinicopathologic characteristics, perioperative details and postoperative outcomes were analyzed. RESULTS The mean operative time was 203.6±26.2min, both proximal and distal tumor-free margins were achieved in all patients. The time for anvil placement at stomach and intestine was 5.9±1.3min and 3.9±0.7min, respectively. Intracorporeal gastrojejunostomy and jejunojejunostomy were successively completed following anvil placement with no any anastomosis-related sutures. There were 5 postoperative complications. Morbidities included pancreas fistula (n=1), stasis (n=2), atelectasis (n=1), pneumonia (n=1). These all patients recovered after conservative treatment. No postoperative anastomosis-related complications, such as anastomotic bleeding and leakage, or stenosis occurred during the median follow-up of 6.5 months. CONCLUSION The initial results suggest that the technique allowing easy and common anvil placement at stomach and intestine may be a simple, safe, preferable and time-saving procedure to accomplish intracorporeal circular-stapled gastrojejunostomy and jejunojejunostomy of Roux-en-Y reconstruction in totally laparoscopic distal gastrectomy as open surgery.
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Affiliation(s)
- Jianjun Du
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Hongyuan Xue
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jin Hua
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lizhi Zhao
- Department of Digestive Surgery, Hanzhong Central Hospital, Hanzhong, Shaanxi, China
| | - Ziqiang Zhang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, Huashan Hospital North, Fudan University, Shanghai, China
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Zhao YN, Xu CP. Etiology, pathogenesis, diagnosis and treatment of bile reflux gastritis. Shijie Huaren Xiaohua Zazhi 2018; 26:1886-1892. [DOI: 10.11569/wcjd.v26.i32.1886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bile reflux gastritis is a common disease of the digestive system, whose clinical characteristics are abdominal pain, abdominal distention and nausea and vomiting, affecting the quality of life of patients seriously. However, the etiology and pathogenesis of bile reflux gastritis are still unclear, which may be related to gastrointestinal surgery, gallbladder disease, Helicobacter pylori infection, psychological factors, etc. There are many diagnostic methods, but a consensus on diagnosis is still lacking. Most of the current treatments are symptomatic treatments, but the overall efficacy is poor. This article reviews the etiology, pathogenesis, diagnosis and treatment of bile reflux gastritis, with an aim to provide a reference for further research of this disease.
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Affiliation(s)
- Ya-Nan Zhao
- Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Cui-Ping Xu
- Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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20
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Seo HS, Jung YJ, Kim JH, Park CH, Lee HH. Three-Port Right-Side Approach-Duet Totally Laparoscopic Distal Gastrectomy for Uncut Roux-en-Y Reconstruction. J Laparoendosc Adv Surg Tech A 2018; 28:1109-1114. [PMID: 30088978 DOI: 10.1089/lap.2018.0331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study presents the initial feasibility of three-port right-side approach-duet totally laparoscopic distal gastrectomy (R-duet TLDG) with uncut Roux-en-Y (R-Y) reconstruction for the treatment of lower- or middle-third gastric cancer. METHODS A total of 30 patients who underwent R-duet TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at the Catholic Medical Center. Reconstructions were performed intracorporeally without special instruments. The clinicopathological characteristics, operative details, postoperative short-term outcomes, and postoperative follow-up endoscopy results were analyzed retrospectively. RESULTS All operations were performed by three-port R-duet TLDG. There were no conversions to an open approach, and no additional ports were placed. The mean operating time was 170 minutes, and the mean number of retrieved lymph nodes was 44. Three patients experienced mild postoperative complications, including small bowel ileus and pneumonia. Follow-up endoscopy was carried out at 3 months. No patients had experienced moderate-or-severe food stasis, alkaline gastritis, or bile reflux during the follow-up period. Recanalization of the biliopancreatic limb was not observed. CONCLUSIONS R-duet TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery without special instruments.
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Affiliation(s)
- Ho Seok Seo
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Yoon Ju Jung
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Ji Hyun Kim
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Cho Hyun Park
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
| | - Han Hong Lee
- Division of Gastrointestinal Surgery, Department of Surgery, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea
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21
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Sun MM, Fan YY, Dang SC. Comparison between uncut Roux-en-Y and Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A meta-analysis. World J Gastroenterol 2018; 24:2628-2639. [PMID: 29962819 PMCID: PMC6021772 DOI: 10.3748/wjg.v24.i24.2628] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/05/2018] [Accepted: 06/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To compare uncut Roux-en-Y (U-RY) gastrojejunostomy with Roux-en-Y (RY) gastrojejunostomy after distal gastrectomy (DG) for gastric cancer.
METHODS A literature search was conducted in Pubmed, Embase, Web of Science, Cochrane Library, Science Direct, Chinese National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database to identify studies comparing U-RY with RY after DG for gastric cancer until the end of December 2017. Pooled odds ratio or weighted mean difference with 95% confidence interval was calculated using either fixed- or random-effects models. Perioperative outcomes such as operative time, intraoperative blood loss, and hospital stay; postoperative complications such as anastomotic bleeding, stricture and ulcer, reflux gastritis/esophagitis, delayed gastric emptying, and Roux stasis syndrome; and postoperative nutritional status (serum hemoglobin, total protein, and albumin levels) were the main outcomes assessed. Meta-analyses were performed using RevMan 5.3 software.
RESULTS Two randomized controlled trials and four nonrandomized observational clinical studies involving 403 and 488 patients, respectively, were included. The results of the meta-analysis showed that operative time [weighted mean difference (WMD): -12.95; 95%CI: -22.29 to -3.61; P = 0.007] and incidence of reflux gastritis/esophagitis (OR: 0.40; 95%CI: 0.20-0.80; P = 0.009), delayed gastric emptying (OR: 0.29; 95%CI: 0.14-0.61; P = 0.001), and Roux stasis syndrome (OR: 0.14; 95%CI: 0.04-0.50; P = 0.002) were reduced; and the level of serum albumin (WMD: 0.71; 95%CI: 0.24-1.19; P = 0.003) was increased in patients undergoing U-RY reconstruction compared with those undergoing RY reconstruction. No differences were found with respect to intraoperative blood loss, hospital stay, anastomotic bleeding, anastomotic stricture, anastomotic ulcer, the levels of serum hemoglobin, and serum total protein.
CONCLUSION U-RY reconstruction has some clinical advantages over RY reconstruction after DG.
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Affiliation(s)
- Ming-Ming Sun
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Yi-Yi Fan
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
| | - Sheng-Chun Dang
- Department of General Surgery, The Affiliated Hospital of Jiangsu University, Zhenjiang 212001, Jiangsu Province, China
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22
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Nakamura K, Suda K, Suzuki A, Nakauchi M, Shibasaki S, Kikuchi K, Nakamura T, Kadoya S, Inaba K, Uyama I. Intracorporeal Isosceles Right Triangle-shaped Anastomosis in Totally Laparoscopic Distal Gastrectomy. Surg Laparosc Endosc Percutan Tech 2018; 28:193-201. [PMID: 29738380 DOI: 10.1097/sle.0000000000000535] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE This study aimed to evaluate the feasibility and safety of intracorporeal anastomosis with Billroth I, Billroth II, or Roux-en-Y reconstructions in totally laparoscopic distal gastrectomy. MATERIALS AND METHODS A single-institution, retrospective, cohort study including 553 patients was conducted. Intracorporeal isosceles right triangle-shaped anastomosis without slack and torsion was created using linear staplers. Billroth I was primarily used. Surgical outcomes and perioperative nutritional status were assessed. RESULTS Morbidity was 11.5%. Postoperative early complications related to anastomosis occurred in 13 patients (2.4%). Operative time and reconstruction type (Billroth I vs. others) were the only significant independent risk factors determining postoperative early and late complications, respectively. No difference was observed in postoperative changes in nutritional status across the groups, although Billroth II increased reflux esophagitis requiring medication. CONCLUSIONS Intracorporeal isosceles right triangle-shaped anastomosis using linear staplers in totally laparoscopic distal gastrectomy, in combination with our selection algorithm for type of reconstruction, is feasible and safe.
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Affiliation(s)
| | - Koichi Suda
- Departments of Surgery, Division of Upper GI
- Department of Surgery, Cancer Center, School of Medicine, Keio University, Tokyo, Japan
| | - Atsushi Suzuki
- Internal Medicine, Division of Endocrinology and Metabolism, Fujita Health University, Aichi
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23
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Braghetto I, Csendes A. SINGLE ANASTOMOSIS GASTRIC BYPASS (ONE ANASTOMOSIS GASTRIC BYPASS OR MINI GASTRIC BYPASS): THE EXPERIENCE WITH BILLROTH II MUST BE CONSIDERED AND IS A CHALLENGE FOR THE NEXT YEARS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:267-271. [PMID: 29340552 PMCID: PMC5793146 DOI: 10.1590/0102-6720201700040010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/08/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Single anastomosis gastric bypass (one anastomosis gastric bypass or mini-gastric bypass) has been presented as an option of surgical treatment for obese patients in order to reduce operation time and avoiding eventual postoperative complications after Roux-en-Y gastric bypass.The main late complication could be related to bile reflux. AIM To report the experiences published after Billroth II anastomosis and its adverse effects regarding symptoms and damage on the gastric and esophageal mucosa . METHOD For data recollection Medline, Pubmed, Scielo and Cochrane database were accessed, giving a total of 168 papers being chosen 57 of them. RESULTS According the reported results during open era surgery for peptic disease and more recent results for gastric cancer surgery, bile reflux and its consequences are more frequent after Billroth II operation compared to Roux-en-Y gastrojejunal anastomosis. CONCLUSION These findings must be considered for the indication of bariatric surgery.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, Faculty of Medicine, University of Chile, Hospital José Joaquin Aguirre, Santiago, Chile
| | - Attila Csendes
- Department of Surgery, Faculty of Medicine, University of Chile, Hospital José Joaquin Aguirre, Santiago, Chile
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24
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Ma JJ, Zang L, Yang A, Hu WG, Feng B, Dong F, Wang ML, Lu AG, Li JW, Zheng MH. A modified uncut Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy: preliminary results and initial experience. Surg Endosc 2017; 31:4749-4755. [PMID: 28411343 DOI: 10.1007/s00464-017-5551-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/28/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the safety and feasibility of totally laparoscopic uncut Roux-en-Y anastomosis in the distal gastrectomy with D2 dissection for gastric cancer. We also summarized the preliminary experience of totally laparoscopic uncut Roux-en-Y anastomosis. METHODS A retrospective analysis was done in 51 cases of total laparoscopic uncut Roux-en-Y anastomosis in the distant gastrectomy with D2 dissection for gastric cancer in our hospital from September 2014 to December 2015. RESULTS All of 51 cases underwent total laparoscopic uncut Roux-en-Y anastomosis. All the procedures were performed successfully. There were neither conversions to open surgery nor intraoperative complications in all 51 cases. In this study, the median operative time was 170 (135-210) min and the median time of anastomosis was 27 (24-41) min. The blood loss was 60 (30-110) ml. The time to flatus and length of postoperative hospital stay were 2 (1-3) days, and 8 (7-12) days, respectively. The mean lymph node harvest was 34 (18-49). One anastomotic bleeding occurred postoperatively which was cured by conservative treatment. No major postoperative complication occurred, such as anastomotic leak, anastomotic stenosis, and Roux stasis syndrome. After a short-term follow-up, no recanalization or reflux gastritis was encountered by endoscopy. CONCLUSION The totally laparoscopic uncut Roux-en-Y anastomosis in distal gastrectomy with lymph node dissection for gastric cancer is safe and feasible, with a very low rate of recanalization and reflux gastritis.
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Affiliation(s)
- Jun-Jun Ma
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Lu Zang
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China. .,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Annie Yang
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Wei-Guo Hu
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Bo Feng
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Feng Dong
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ming-Liang Wang
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ai-Guo Lu
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Jian-Wen Li
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Min-Hua Zheng
- Department of General Surgery, RuiJin Hospital, Shanghai Jiao-Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China.,Shanghai Minimal Invasive Surgery Center, 197 Ruijin Er Road, Shanghai, 200025, China
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25
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Outcomes From an Enhanced Recovery Program for Laparoscopic Gastric Surgery. Surg Laparosc Endosc Percutan Tech 2017; 26:e50-5. [PMID: 27258917 DOI: 10.1097/sle.0000000000000277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the outcomes from an enhanced recovery after surgery (ERAS) program for laparoscopic gastric surgery. MATERIALS AND METHODS This was a prospective study of patients undergoing elective laparoscopic gastric resection in an ERAS protocol at a single institution between 2008 and 2012. Outcomes included the length of hospital stay, intraoperative and postoperative complications, the readmission rate, the reoperation rate, and the 30-day mortality. RESULTS Of the 86 patients, 60 underwent partial gastrectomy and 26 underwent total gastrectomy. Median lymph nodes sampled was 15 (range, 9 to 47). The median length of hospital stay was 4 (range, 1 to 44) days. The conversion rate to open surgery was 11.6%. Four patients (4.7%) had an anastomotic leak. Three patients had postoperative bleeding (4.7%). About 4.7% (n=4) of the patients required readmission and 8.1% required reoperation (n=7). The 30-day mortality rate was 2.3% (n=2) due to complications from anastomotic leak. CONCLUSIONS Laparoscopic gastrectomy within an ERAS protocol results in a short hospital stay with an acceptable morbidity and mortality rate.
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26
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Haverkamp L, Brenkman HJF, Seesing MFJ, Gisbertz SS, van Berge Henegouwen MI, Luyer MDP, Nieuwenhuijzen GAP, Wijnhoven BPL, van Lanschot JJB, de Steur WO, Hartgrink HH, Stoot JHMB, Hulsewé KWE, Spillenaar Bilgen EJ, Rütter JE, Kouwenhoven EA, van Det MJ, van der Peet DL, Daams F, Draaisma WA, Broeders IAMJ, van Stel HF, Lacle MM, Ruurda JP, van Hillegersberg R. Laparoscopic versus open gastrectomy for gastric cancer, a multicenter prospectively randomized controlled trial (LOGICA-trial). BMC Cancer 2015; 15:556. [PMID: 26219670 PMCID: PMC4518687 DOI: 10.1186/s12885-015-1551-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/14/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND For gastric cancer patients, surgical resection with en-bloc lymphadenectomy is the cornerstone of curative treatment. Open gastrectomy has long been the preferred surgical approach worldwide. However, this procedure is associated with considerable morbidity. Several meta-analyses have shown an advantage in short-term outcomes of laparoscopic gastrectomy compared to open procedures, with similar oncologic outcomes. However, it remains unclear whether the results of these Asian studies can be extrapolated to the Western population. In this trial from the Netherlands, patients with resectable gastric cancer will be randomized to laparoscopic or open gastrectomy. METHODS The study is a non-blinded, multicenter, prospectively randomized controlled superiority trial. Patients (≥18 years) with histologically proven, surgically resectable (cT1-4a, N0-3b, M0) gastric adenocarcinoma and European Clinical Oncology Group performance status 0, 1 or 2 are eligible to participate in the study after obtaining informed consent. Patients (n = 210) will be included in one of the ten participating Dutch centers and are randomized to either laparoscopic or open gastrectomy. The primary outcome is postoperative hospital stay (days). Secondary outcome parameters include postoperative morbidity and mortality, oncologic outcomes, readmissions, quality of life and cost-effectiveness. DISCUSSION In this randomized controlled trial laparoscopic and open gastrectomy are compared in patients with resectable gastric cancer. It is expected that laparoscopic gastrectomy will result in a faster recovery of the patient and a shorter hospital stay. Secondly, it is expected that laparoscopic gastrectomy will be associated with a lower postoperative morbidity, less readmissions, higher cost-effectiveness, better postoperative quality of life, but with similar mortality and oncologic outcomes, compared to open gastrectomy. The study started on 1 December 2014. Inclusion and follow-up will take 3 and 5 years respectively. Short-term results will be analyzed and published after discharge of the last randomized patient. TRIAL REGISTRATION NCT02248519.
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Affiliation(s)
- Leonie Haverkamp
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Hylke J F Brenkman
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Maarten F J Seesing
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Suzanne S Gisbertz
- Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | | | - Misha D P Luyer
- Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | | | - Bas P L Wijnhoven
- Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Jan J B van Lanschot
- Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Wobbe O de Steur
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Henk H Hartgrink
- Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jan H M B Stoot
- Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands.
| | - Karel W E Hulsewé
- Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands.
| | | | - Jeroen E Rütter
- Rijnstate Hospital, Wagnerlaan 55, 6815AD , Arnhem, The Netherlands.
| | - Ewout A Kouwenhoven
- ZGT Hospitals, location Almelo, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.
| | - Marc J van Det
- ZGT Hospitals, location Almelo, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.
| | - Donald L van der Peet
- VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.
| | - Freek Daams
- VU University Medical Center, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.
| | - Werner A Draaisma
- Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
| | - Ivo A M J Broeders
- Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
| | - Henk F van Stel
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Miangela M Lacle
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Jelle P Ruurda
- University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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