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Wang J, Liu S, Chen H, Luo J, Xu G, Feng X, Yang X, Yang J, Gang J. Final results of a randomized controlled trial: comparison of the efficacy and safety between totally laparoscopic and laparoscopic-assisted total gastrectomy for advanced Siewert III esophagogastric junction cancer and upper and middle third gastric cancer. Int J Surg 2025; 111:686-696. [PMID: 39185962 PMCID: PMC11745745 DOI: 10.1097/js9.0000000000002062] [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: 04/15/2024] [Accepted: 08/11/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND This study aimed to compare the efficacy and safety of TLTG with the overlap technique to LATG in patients with advanced Siewert III Esophagogastric Junction Cancer and upper and middle third gastric cancer. METHODS This single-center RCT enrolled 292 patients with the mentioned cancers, randomly assigned to TLTG overlap ( n =146) or LATG ( n =146) groups. Data on demographics, pathology, intraoperative variables, postoperative complications, recovery parameters, and 3-year survival were collected. Main outcome: postoperative complications within 30 days. Secondary outcomes: 3-year disease-free and overall survival. RESULTS TLTG versus LATG: TLTG had shorter incision, faster flatus/defecation, reduced analgesia, less opioid use, and shorter hospital stay. Similar operation time, anastomosis time, blood loss, and lymph node harvest. TLTG had a lower overall post-op complication rate (P=0.047) and no significant difference in serious complications ( P =0.310). Variances in anastomotic stenosis occurrence at 3 months. No rehospitalization or mortality at 30 days. No significant differences in 3-month disease-free survival ( P =0.058) or overall survival ( P =0.236). CONCLUSION The overlap method for anastomosis in TLTG is safe and feasible for advanced middle-upper-third gastric cancer, with positive short-term outcomes. This technique has the potential to be the preferred esophagojejunostomy approach in TLTG. TRIAL REGISTRATION This trial has been registered at Chinese Clinical Trial Registry: ChiCTR1900025667 (registration date: 4 September 2019).
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
- National Key Laboratory for Integrated Prevention and Treatment of Digestive System Tumors, Xi’an
| | - Shushang Liu
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Haixiang Chen
- Medical Record Department, Nanjing Hospital of C.M. Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
| | - Jialin Luo
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Guanghui Xu
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Xiangying Feng
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Xuewen Yang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
| | - Jianjun Yang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
- National Key Laboratory for Integrated Prevention and Treatment of Digestive System Tumors, Xi’an
| | - Ji Gang
- Department of Digestive Surgery, The First Affiliated Hospital of Air Force Military Medical University
- National Key Laboratory for Integrated Prevention and Treatment of Digestive System Tumors, Xi’an
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Wang ZQ, Liu YH, Cui WL, Ma MY, Wang J, Wang YP, Hua LC, Hong J, Hao HK. The safety and feasibility assessment of overlap esophagojejunostomy with self-pulling and latter transection technique in totally laparoscopic total gastrectomy. J Gastrointest Surg 2024; 28:1223-1228. [PMID: 38705366 DOI: 10.1016/j.gassur.2024.04.031] [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: 02/21/2024] [Revised: 04/08/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND This study presented an innovative technique in totally laparoscopic total gastrectomy (TLTG) for overlap esophagojejunostomy (E-J), termed self-pulling and latter transection (SPLT) (overlap SPLT). It evaluated the effectiveness and short-term outcomes of this novel method through a comparative analysis with the established functional end-to-end (FETE) E-J incorporating SPLT. METHODS From September 2018 to September 2023, this study enrolled 68 patients with gastric cancer who underwent TLTG with overlap SPLT anastomosis and 120 patients who underwent TLTG with FETE SPLT anastomosis. Clinicopathologic characteristics and surgical and postoperative outcomes data for overlap SPLT cases were gathered and retrospectively compared with those from FETE SPLT TLTG to evaluate the effectiveness and clinical safety. RESULTS The duration of anastomosis for overlap SPLT was 25.3 ± 7.4 minutes, significantly longer than that for the FETE SPLT (18.1 ± 4.0 minutes, P = .031). Perioperatively, 1 anastomosis-related complication occurred in each group, but this did not constitute a statistically significant difference (P = .682). No statistically significant differences were found between the 2 groups in terms of operative time, postoperative hospital stay, operative cost, surgical margins, or number of lymph nodes removed. Postoperative morbidity rates were similar between the groups (4.4% vs 5.8%, P = .676). CONCLUSION The overlap SPLT technique is regarded as a safe and feasible method for anastomosis. There were no apparent differences in complications between overlap SPLT and FETE SPLT, but overlap SPLT costed 1 additional stapler cartridge and required a longer duration.
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Affiliation(s)
- Ze-Qin Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Yan-Hong Liu
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Wen-Liang Cui
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Ming-Ye Ma
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Jian Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Ya-Ping Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Lu-Chun Hua
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China
| | - Jun Hong
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China.
| | - Han-Kun Hao
- Department of General Surgery, Huashan Hospital, Fudan University, Jing'an District, Shanghai, China.
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Lee SS. Endoscopic management of pseudo-lumen stapling following laparoscopic esophagojejunostomy: A case report. Int J Surg Case Rep 2023; 111:108830. [PMID: 37716056 PMCID: PMC10509695 DOI: 10.1016/j.ijscr.2023.108830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION Pseudo-lumen stapling can occur following an incidental submucosal introduction of a fork of the linear stapler into the esophageal side during esophagojejunostomy (EJS) after total gastrectomy. This leaves a mucosa-covered layer over the EJS site that can eventually cause an obstruction. If it is noticed intraoperatively, an immediate surgical take-down and repeat anastomosis might be chosen by most surgeons. However, these procedures might have side effects such as further dissection into the esophageal hiatus and unnecessary tension on the anastomosis. To our knowledge, no existing publication has presented a non-surgical management method for pseudo-lumen stapling. PRESENTATION OF CASE A 64-year-old male underwent laparoscopic total gastrectomy with a pseudo-lumen stapling unnoticed during surgery. Upon its recognition on the third postoperative day, endoscopic release of the tissue covering the anastomosis was performed. The procedure was successful. Gastrographic examination on the sixth postoperative day confirmed a good passage of the contrast agent. Postoperative one-year endoscopic examination confirmed patent anastomosis without stenosis. DISCUSSION Although pseudo-lumen stapling is one of the most unwanted consequences of EJS using linear staplers, there is little information or documentation available as reference for cases encountered during clinical practice. This might be related to the tendency of surgeons to perform an immediate take-down, followed by repeat EJS when this is noticed during surgery. We were able to successfully overcome this problem without surgery following a series of early gastrographic and endoscopic procedures. CONCLUSION Endoscopic release of the covering tissue should be considered a valid non-surgical solution to pseudo-lumen stapling.
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Affiliation(s)
- Seung Soo Lee
- Department of Surgery, Kyungpook National University Hospital 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea
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Manaka D, Konishi S, Kawaguchi K, An H, Hamasu S, Yoneda M, Fushitani M, Ota T, Morioka M, Okamura Y, Ikeda A, Sasaki N, Nishitai R. A novel method of anvil placement of circular stapler for esophagojejunostomy in laparoscopic total gastrectomy for gastric cancer: results of consecutive 200 cases. Surg Endosc 2023; 37:1021-1030. [PMID: 36097097 DOI: 10.1007/s00464-022-09566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/14/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic total gastrectomy for gastric cancer is still a demanding operation because of technical difficulties, especially of intracorporeal esophago-jejunal anastomosis. METHODS We introduced a newly designed method of anvil placement of circular stapling devices (CS) for laparoscopic esophagojejunostomy (EJS). A small incision was made on the anterior wall of the stomach, from which the anvil was inserted into the stomach and proceeded to the thoracic esophagus. Then, the abdominal esophagus was transected by a linear stapler, and the anvil into the esophagus was drawn back to the esophageal stump by pulling out the cotton tape pre-attached to the anvil. Intracorporeal EJS by Roux-en-Y reconstruction was performed by CS inserted into the abdominal cavity from the umbilical wound. RESULTS A total of consecutive 200 gastric cancer patients underwent laparoscopic total gastrectomy using this method. There was no operative mortality. Anastomotic complications occurred in 12 cases (6.0%): 9 cases of stenosis (4.5%) and 3 cases of bleedings (1.5%). Anastomotic leakage was not observed. As for non-anastomotic complications, there occurred 2 pulmonary complications (1.0%), 3 pancreatic leakages (1.5%), and 8 bowel obstructions due to internal hernia (4.0%). With a median follow-up period of 47.1 months, 5-year overall survival for assessable patients (n = 193) was 60.3% (95% CI 52.6-67.2). The total rate of peritoneal recurrence was 9.8%. CONCLUSION Our new method of anvil placement for laparoscopic EJS with CS is safe and feasible with favorable survival outcomes. It eliminates the need for suturing, and will promote the clinical application of laparoscopic total gastrectomy for gastric cancer. CLINICAL TRIALS UMIN000046119.
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Affiliation(s)
- Dai Manaka
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan.
| | - Sayuri Konishi
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Kiyotaka Kawaguchi
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Hideo An
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Shinya Hamasu
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Machi Yoneda
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Masashi Fushitani
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Takano Ota
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Michina Morioka
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Yusuke Okamura
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Atsushi Ikeda
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Naoya Sasaki
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
| | - Ryuta Nishitai
- Department of Surgery, Gastrointestinal Center, Kyoto Katsura Hospital, 17, Hirao-cho, Yamada, Nishikyo-ku, Kyoto, 615-8256, Japan
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Guo Z, Deng C, Zhang Z, Liu Y, Qi H, Li X. Safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer: A systematic review and meta-analysis. Int J Surg 2022; 102:106684. [DOI: 10.1016/j.ijsu.2022.106684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/30/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023]
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Kapuller V, Kammar H, Zugayyar D, Luques L, Michael S, Arbell D. Bowel Resection Through a Single Umbilical Incision: A Case Series. J Laparoendosc Adv Surg Tech A 2022; 32:448-451. [PMID: 34990296 DOI: 10.1089/lap.2021.0610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The advent of laparoscopy has revolutionized surgery. The surgeon strives to minimize incisions and their adverse consequences. Although laparoscopy has gained widespread popularity, several advantages in open surgery are thereby lost. Tactile sensation of the tissue, hand-sewn anastomosis, and nonthermic vascular control are most prominent. To combine both approaches, single incision laparoscopic-assisted surgery (SILS) was advanced, trying to combine the best in both worlds. This approach is widely used in appendectomies. After having gained experience in this approach, we expanded the indications and hereby present our experience with bowel resections utilizing SILS. Patients and Methods: Data were collected retrospectively from operations performed during the past 3 years. We found 11 cases of SILS bowel resections: 3 sigmoidectomies, 3 small bowel atresia repairs, 1 subtotal colectomy, 1 Meckel's diverticulectomy, and 3 resections of bowel duplications. The age of the patients ranged from 2 days to 17 years. In all cases, a working 10 mm scope was inserted through the umbilicus, the bowel was extracted outside the abdomen through the umbilicus, dissection and resection with anastomosis were performed outside the abdomen in the classic open approach, and the bowel was returned to the abdomen. Results and Conclusions: All patients recovered promptly with no need for further intervention. There were no cases of wound infection, leak, or intra-abdominal abscess formation. Cosmesis was excellent with a small umbilical scar. We conclude that this approach is feasible and safe in a select population.
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Affiliation(s)
- Vadim Kapuller
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Haguy Kammar
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Diaa Zugayyar
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Lisandro Luques
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Samer Michael
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
| | - Dan Arbell
- The Department of Pediatric Surgery, Hadassah University Hospital, Hebrew University, Jerusalem, Israel
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Chen C, Wei M, Feng X, Han H, Wang C, He Q, Yu W. Comparison of reverse puncture device and overlap in laparoscopic total gastrectomy for gastric cancer. J Minim Access Surg 2022; 18:31-37. [PMID: 33047683 PMCID: PMC8830560 DOI: 10.4103/jmas.jmas_276_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Intracorporeal oesophagojejunostomy is one of the key steps in laparoscopic total gastrectomy (LTG). At present, there is no widely accepted anastomosis technique in oesophagojejunostomy. MATERIALS AND METHODS We retrospectively studied 63 patients with gastric cancer who underwent LTG. Two types of anastomosis techniques have been applied during LTG: the reverse puncture device (RPD) (28 patients) and overlap (35 patients). RESULTS A total of 63 patients (51 males and 12 females: mean age = 58 years and mean body mass index [BMI] = 26.3 kg/m2) were enrolled in this study. There were no significant difference in age, BMI, duration of surgery, duration of anastomosis, blood loss, post-operative hospital stay, tumour location, tumour size, degree of tumour differentiation, Borrmann type, total number of lymph nodes, number of positive lymph nodes, hospital stay, hospitalisation costs, intra-operative complications, post-operative complications and prognosis between the RPD group and the overlap group. RPD group showed a significant advantage in terms of the distance between the top border of tumours and the top resection margin (P < 0.001). We further found that the oesophageal lateral negative surgical margin distance of the upper gastric cancer in the RPD group was significantly longer than that in the overlap group (P < 0.001). CONCLUSIONS Both the RPD and overlap techniques are safe and applicable in LTG. However, RPD has the advantage of obtaining an adequate safe margin compared with that of overlap technique, especially in patients with gastro-oesophageal junction carcinoma.
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Affiliation(s)
- Cheng Chen
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Meng Wei
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xingbo Feng
- Department of General Surgery, Central Hospital of Zaozhuang Coal Mining Group, Shandong Province, Zaozhuang, China
| | - Haifeng Han
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chao Wang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Qingsi He
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Wenbin Yu
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China
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A Multicenter Retrospective Study Comparing Surgical Outcomes Between the Overlap Method and Functional Method for Esophagojejunostomy in Laparoscopic Total Gastrectomy: Analysis Using Propensity Score Matching. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:89-95. [PMID: 34545031 DOI: 10.1097/sle.0000000000001008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to compare the postoperative outcomes after laparoscopic total gastrectomy (LTG) with esophagojejunostomy (EJS) performed using the overlap method or the functional method in a multicenter retrospective study with propensity score matching. METHODS We retrospectively enrolled all patients who underwent curative LTG for gastric cancer at 6 institutions between January 2004 and December 2018. Patients were categorized into the overlap group (OG) or functional group (FG) based on the type of anastomosis used in EJS. Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage. The surgical results and postoperative outcomes were compared. RESULTS We identified 69 propensity score-matched pairs among 440 patients who underwent LTG. There was no significant between-group difference in the median operative time, intraoperative blood, or number of lymph nodes resected. In terms of postoperative outcomes, the rates of all complications [Clavien-Dindo (CD) classification ≥II; OG 13.0 vs. FG 24.6%, respectively; P=0.082], complications more severe than CD grade III (OG 8.7 vs. FG 18.8%, respectively; P=0.084), and the occurrence of EJS leakage and stenosis more severe than CD grade III (OG 7.3% vs. FG 2.9%, P=0.245; OG 1.5 vs. FG 8.7%, P=0.115, respectively) were comparable. The median follow-up period was 830 days (range, 18 to 3376 d), and there were no differences in overall survival between the 2 groups. CONCLUSIONS There was no difference in surgical outcomes and overall survival based on the type of anastomosis used for EJS after LTG. Therefore, selection of anastomosis in EJS should be based on each surgeon's preference and experience.
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Wang Y, Liu Z, Shan F, Ying X, Zhang Y, Li S, Jia Y, Jiang Z, Yang X, Li B, Li Z, Ji J. Short-term outcomes after totally laparoscopic total gastrectomy with esophagojejunostomy constructed by π-shaped method versus overlap method. J Surg Oncol 2021; 124:1329-1337. [PMID: 34432310 DOI: 10.1002/jso.26642] [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: 04/14/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Regarding the overlap anastomosis and recently introduced π-shaped anastomosis, there is no consensus on which intracorporeal esophagojejunostomy (EJS) methods are preferred using linear stapler in totally laparoscopic total gastrectomy (TLTG). This study aims to evaluate the short-term outcomes using two methods. METHODS Patients with upper gastric cancer underwent TLTG with either π-shaped (n = 48) or the modified overlap method using knotless barbed sutures (MOBS) (n = 37) were included in our study. Intraoperative and perioperative outcomes were compared. RESULTS All patients achieved R0 resection margin. The overall esophagojejunal (E-J)-related complications rate was 7.06%. There was no significant difference between the two groups in terms of postoperative complications, margin distance, numbers of lymph nodes (LNs), length of stay. In the π-shaped group, anastomosis time (19.61 ± 7.17 min vs. 27.09 ± 3.59 min, p < 0.001) was significantly lower. The consumable costs for surgery were similar (44 507.74¥ [42 933.03-46 937.29] vs. 43 718.36¥ [42 743.25-47 256.06], p = 0.825). The first defection time was significantly longer in π-shaped group (131.00 h [93.75-171.25] vs. 100.00 h [85.00-120.00], p = 0.026), whereas the other postoperative recovery parameters were similar. No mortality was observed. CONCLUSIONS Both methods showed similar short-term postoperative outcomes. The π-shaped technique was faster than the MOBS method without significantly increasing the supplies costs. Large prospective studies are warranted.
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Affiliation(s)
- Yinkui Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zining Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangji Ying
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuangxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yongning Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zijian Jiang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xuesong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Bailong Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, China
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Fluorescent lymphography during minimally invasive total gastrectomy for gastric cancer: an effective technique for splenic hilar lymph node dissection. Surg Endosc 2021; 36:2914-2924. [PMID: 34109482 DOI: 10.1007/s00464-021-08584-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Fluorescent lymphography is an excellent technique for complete lymph node dissection during minimally invasive surgery for gastric cancer. This study aimed to evaluate the role of fluorescent lymphography in splenic hilar lymph node dissection during minimally invasive total gastrectomy. METHODS We retrospectively analyzed 168 gastric cancer patients who underwent minimally invasive total gastrectomy with D2 + No. 10 lymph node dissection from 2013 to 2018. Fluorescent lymphography was used whenever it is possible. However, when near-infrared imaging system and endoscopic indocyanine green injection were not available, we performed surgery without fluorescent lymphography. A total of 74 patients underwent surgery with fluorescent lymphography (FL group) and 94 underwent surgery without it (non-FL group). Perioperative and long-term outcomes including the number of retrieved lymph nodes at each nodal station were compared between groups. RESULTS The median number of retrieved lymph nodes at the splenic hilum was larger in the FL group {2.5 [Interquartile range (IQR), 1-5]} than in the non-FL group [1 (IQR, 1-3); P = 0.012]. The negative predictive value of fluorescent lymphography for lymph node metastasis at the splenic hilum was 97.1%, although the sensitivity was 66.7%. The overall survival (FL: 96.9% vs. non-FL: 88.9%; P = 0.334) and relapse-free survival (FL: 90.5% vs. non-FL: 65.5%; P = 0.054) were higher in the FL group, although there were no statistical differences. However, among the patients without lymph node metastasis, the relapse-free survival was significantly higher in the FL group (100%) than in the non-FL group (67.1%; P = 0.017). CONCLUSIONS Fluorescent lymphography is an effective tool for complete lymph node dissection at the splenic hilum. Moreover, it may help select patients who do not need splenic hilar lymph node dissection during a total gastrectomy.
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Wang J, Yang J, Yang XW, Li XH, Yang JJ, Ji G. Comparison of Outcomes of Totally Laparoscopic Total Gastrectomy (Overlap Reconstruction) versus Laparoscopic-Assisted Total Gastrectomy for Advanced Siewert III Esophagogastric Junction Cancer and Gastric Cancer of Upper and Middle Third of Stomach: Study Protocol for a Single-Center Randomized Controlled Trial. Cancer Manag Res 2021; 13:595-604. [PMID: 33519239 PMCID: PMC7837541 DOI: 10.2147/cmar.s285598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Totally laparoscopic total gastrectomy (TLTG) using the overlap reconstruction method is associated with fewer postoperative complications and fast recovery than laparoscopic-assisted radical total gastrectomy (LATG). However, evidence on the safety and feasibility of TLTG (overlap reconstruction) in patients with advanced Siewert III esophagogastric junction cancer and gastric cancer of the upper and middle third of the stomach is scarce. Methods This study is a prospective, single-center, single-blind, two-arm randomized controlled trial designed to include 292 patients with advanced Siewert III esophagogastric junction cancer and gastric cancer of the upper and middle third of the stomach who will be randomly assigned to two groups: a TLTG overlap group (n=146) and an LATG group (n=146). The patients’ demographics, pathological characteristics, intraoperative variables, postoperative complications, postoperative recovery variables, 3-year disease-free survival and 3-year overall survival will be collected and analyzed. The primary outcome is the postoperative complications within 30 days after surgery including intra-abdominal hemorrhage, anastomotic leakage, duodenal stump fistula, pancreatic fistula, chyle leakage, abdominal infection, intestinal obstruction, wound complications, pulmonary infection, pleural effusion, pulmonary embolism, cardiovascular and cerebrovascular complications, and deep vein thrombosis. The secondary outcomes are the 3-year disease-free survival and 3-year overall survival. Discussion This trial will provide high-level evidence for the safety and feasibility of TLTG (overlap reconstruction) compared with LATG in advanced Siewert III esophagogastric junction cancer and the upper and middle third of gastric cancer. Trial Registration This trial has been registered at the Chinese Clinical Trial Registry: ChiCTR1900025667 (registration date: September 4, 2019).
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jun Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xue Wen Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xiao Hua Li
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jian Jun Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Gang Ji
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
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Tian P, Liu Y, Bian S, Li M, Zhang M, Liu J, Jin L, Zhang P, Zhang Z. Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 10:607922. [PMID: 33585228 PMCID: PMC7874144 DOI: 10.3389/fonc.2020.607922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To compare laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) with regard to outcomes, including efficacy and safety, in patients with proximal gastric cancer. METHODS Original English-language articles comparing LPG and LTG for proximal gastric cancer up to November 2019 were systematically searched in the Embase, PubMed, Cochrane Library, Web of Knowledge, and ClinicalTrials.gov databases by two independent reviewers. Our main endpoints were surgery-related features (operation time, blood loss, harvested lymph nodes, and postoperative hospital stay), postoperative complications (anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis), and oncologic outcomes (5-year overall survival and recurrent cancer). RESULTS Fourteen studies including a total of 1,282 cases (510 LPG and 772 LTG) were enrolled. Fewer lymph nodes were harvested (WMD = -13.33, 95% CI: -15.66 to -11.00, P < 0.00001) and more postoperative anastomotic stenosis (OR = 2.03, 95% CI: 1.21 to 3.39, P = 0.007) observed in LPG than LTG. There were no significant differences in other explored parameters between the two methods. However, based on a subgroup analysis of digestive tract reconstruction, LPG with esophagogastrostomy (LPG-EG) had shorter operative time (WMD = -42.51, 95% CI: -58.99 to -26.03, P < 0.00001), less intraoperative blood loss (WMD = -79.52, 95% CI: -116.63 to -42.41, P < 0.0001), and more reflux esophagitis (OR = 3.92, 95% CI: 1.56 to 9.83, P = 0.004) than was observed for LTG. There was no difference between LPG performed with the double tract anastomosis/double-flap technique (DT/DFT) and LTG. CONCLUSION LPG can be performed as an alternative to LTG for proximal gastric cancer, especially LPG-DT/DFT, with comparable safety and efficacy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University and National Clinical Research Center for Digestive Diseases, Beijing, China
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Nomura E, Kayano H, Seki T, Abe R, Yoshii H, Uda S, Kazuno A, Izumi H, Yamamoto S, Mukai M, Makuuchi H. Preventive procedure for stenosis after esophagojejunostomy using a circular stapler and transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy and total gastrectomy involving reduction of anastomotic tension. BMC Surg 2021; 21:47. [PMID: 33478457 PMCID: PMC7818772 DOI: 10.1186/s12893-021-01054-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/06/2021] [Indexed: 01/08/2023] Open
Abstract
Background Recently, due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy (LPG) and total gastrectomy (LTG), linear staplers are being used instead. We investigated our preventive procedure for esophagojejunostomy stenosis following use of circular staplers. Methods Since the anastomotic stenosis is considered to be mainly caused by tension in the esophageal and jejunal stumps at the anastomotic site, we have been performing procedures to relieve this tension, by cutting off the rubber band and pushing the shaft of the circular stapler toward the esophageal side, since July 2015. We retrospectively compared the incidence of anastomotic stenosis in cases of LPG and LTG performed before July 2015 (early phase, 30 cases) versus those performed after this period (later phase, 22 cases). Results Comparison of the incidence of anastomotic stenosis according to the type of surgery, LPG or LTG, and between the two time periods versus all cases, indicated a significantly lower incidence in the later phase than in the early phase (4.5 vs. 26.7%, p < 0.05), especially for LPG (0 vs. 38.5%, p < 0.05). Conclusions It is possible to use a circular stapler during laparoscopic esophagojejunostomy, as with open surgery, if steps to reduce tension on the anastomotic site are undertaken. These procedures will contribute to the spread of safe and simple laparoscopic anastomotic techniques.
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Affiliation(s)
- Eiji Nomura
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan.
| | - Hajime Kayano
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Takatoshi Seki
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Rin Abe
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Hisamichi Yoshii
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Shuji Uda
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Akihito Kazuno
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Hideki Izumi
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Soichiro Yamamoto
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Masaya Mukai
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
| | - Hiroyasu Makuuchi
- Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo, 192-0032, Japan
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Braghetto I, Lanzarini E, Musleh M, GutiÉrrez L, Molina JC, Korn O, Figueroa M, Lasnibat JP, Orellana O. LESSONS LEARNED ANALYZING COMPLICATIONS AFTER LAPAROSCOPIC TOTAL GASTRECTOMY FOR GASTRIC CANCER. ACTA ACUST UNITED AC 2020; 33:e1539. [PMID: 33331434 PMCID: PMC7747491 DOI: 10.1590/0102-672020200003e1539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/19/2020] [Indexed: 12/02/2022]
Abstract
Background:
Laparoscopic surgery has been gradually accepted as an option for the
surgical treatment ofgastric cancer. There are still points that are
controversial or situations that are eventually associated with
intra-operative difficulties or postoperative complications.
Aim:
To establish the relationship between the difficulties during the execution
of total gastrectomy and the occurrence of eventual postoperative
complications.
Method:
The operative protocols and postoperative evolution of 74 patients operated
for gastriccancer, who were subjected to laparoscopic total gastrectomy
(inclusion criteria) were reviewed. The intraoperative difficulties recorded
in the operative protocol and postoperative complications of a surgical
nature wereanalyzed (inclusion criteria). Postoperative medical
complications were excluded (exclusion criteria). For the discussion, an
extensive bibliographical review was carried out.
Results:
Intra-operative difficulties or complications reported correspond to 33/74
and of these; 18 events (54.5%) were related to postoperative complications
and six were absolutely unexpected. The more frequent were leaks of the
anastomosis and leaks of the duodenal stump; however, other rare
complications were observed. Seven were managed with conservative measures
and 17 (22.9%) required surgical re-exploration, with a postoperative
mortality of two patients (2.7%).
Conclusion:
We have learned that there are infrequent and unexpected complications; the
treating team must be mindful of and, in front of suspicion of
complications, anappropriate decision must be done which includes early
re-exploration. Finally, after the experience reported, some complications
should be avoided.
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Affiliation(s)
- Italo Braghetto
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Enrique Lanzarini
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Maher Musleh
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis GutiÉrrez
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan Carlos Molina
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Manuel Figueroa
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Juan Pablo Lasnibat
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Omar Orellana
- Department of Surgery, Hospital José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
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Comparison of surgical outcomes among different methods of esophagojejunostomy in laparoscopic total gastrectomy for clinical stage I proximal gastric cancer: results of a single-arm multicenter phase II clinical trial in Korea, KLASS 03. Surg Endosc 2020; 35:1156-1163. [PMID: 32144557 DOI: 10.1007/s00464-020-07480-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic distal gastrectomy for early gastric cancer has been widely accepted, but laparoscopic total gastrectomy has still not gained popularity because of technical difficulty and unsolved safety issue. We conducted a single-arm multicenter phase II clinical trial to evaluate the safety and the feasibility of laparoscopic total gastrectomy for clinical stage I proximal gastric cancer in terms of postoperative morbidity and mortality in Korea. The secondary endpoint of this trial was comparison of surgical outcomes among the groups that received different methods of esophagojejunostomy (EJ). METHODS The 160 patients of the full analysis set group were divided into three groups according to the method of EJ, the extracorporeal circular stapling group (EC; n = 45), the intracorporeal circular stapling group (IC; n = 64), and the intracorporeal linear stapling group (IL; n = 51). The clinicopathologic characteristics and the surgical outcomes were compared among these three groups. RESULTS There were no significant differences in the early complication rates among the three groups (26.7% vs. 18.8% vs. 17.6%, EC vs. IC vs. IL; p = 0.516). The length of mini-laparotomy incision was significantly longer in the EC group than in the IC or IL group. The anastomosis time was significantly shorter in the EC group than in the IL group. The time to first flatus was significantly shorter in the IL group than in the EC group. The long-term complication rate was not significantly different among the three groups (4.4% vs. 12.7% vs. 7.8%; EC vs. IC vs. IL; p = 0.359), however, the long-term incidence of EJ stenosis in IC group (10.9%) was significantly higher than in EC (0%) and IL (2.0%) groups (p = 0.020). CONCLUSIONS The extracorporeal circular stapling and the intracorporeal linear stapling were safe and feasible in laparoscopic total gastrectomy, however, intracorporeal circular stapling increased EJ stenosis.
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Overlap method versus functional method for esophagojejunal reconstruction using totally laparoscopic total gastrectomy. Surg Endosc 2020; 35:130-138. [PMID: 31938929 DOI: 10.1007/s00464-020-07370-5] [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] [Received: 02/09/2019] [Accepted: 01/04/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic intracorporeal esophagojejunostomy (EJ) is a useful method in totally laparoscopic total gastrectomy (TLTG) for treating upper-third gastric cancer. The two methods of laparoscopic intracorporeal EJ-functional and overlap-have not been compared side-by-side in terms of safety and feasibility. METHODS Retrospective review and analysis of the data of 490 consecutive patients who underwent TLTG by either functional method (n = 365) or overlap (n = 125) method for upper- or middle-third gastric cancer was conducted between January, 2011 and May, 2018 at Asan Medical Center (Seoul, Korea). One-to-one propensity score matching (PSM) was performed to compare age, sex, body mass index, American Society of Anesthesiologist score, the presence of comorbidity, number of comorbidities, clinical T stage, clinical nodal stage, clinical TNM stage, history of previous abdominal surgery, and combined surgery. After PSM, 244 patients were divided into functional method group and overlap method group (n = 122, each). The surgical outcomes and EJ-related complications were compared between the two groups. RESULTS No significant difference was found between the two groups in terms of early surgical outcomes such as operative time, time to first flatus, postoperative hospital stay, transfusion during surgery, transfusion after surgery, and administration of analgesics. However, the pain score was significantly lower in overlap method group (6.21 ± 1.83) than functional method group (6.97 ± 2.09, p < 0.05). The overlap method was also associated with significantly fewer late complications (3.28% vs. 12.30%; p < 0.05), lower Clavien-Dindo classification grade (p < 0.05), and fewer EJ-related complications (0.82% vs. 6.56%; p < 0.05), as compared with the functional method. CONCLUSION The overlap method was safer and more feasible than the functional method for TLTG in gastric cancer patients, based on the finding of significantly lower incidence of EJ-related complications.
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Park KB, Kim EY, Song KY. Esophagojejunal Anastomosis after Laparoscopic Total Gastrectomy for Gastric Cancer: Circular versus Linear Stapling. J Gastric Cancer 2019; 19:344-354. [PMID: 31598376 PMCID: PMC6769364 DOI: 10.5230/jgc.2019.19.e34] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/08/2019] [Accepted: 09/16/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose No standard technique has been established for esophagojejunal anastomosis during laparoscopic total gastrectomy (LTG) for gastric cancer owing to the technical difficulty and high complication rate of this procedure. This study was performed to compare the short-term outcomes of circular and linear stapling methods after LTG. Materials and Methods A total of 106 patients treated between July 2010 and July 2018 were divided into 2 groups according to the following anastomosis procedures: hemi-double-stapling technique (HDST; circular stapling method; group C, n=77) or overlap method (linear stapling method; group L, n= 29). The clinicopathological features and postoperative outcomes, including complications, were analyzed. Multivariate analysis was performed using a logistic regression model to identify the independent risk factors for anastomotic complications. Results The incidence of anastomotic complications was significantly higher in group C than in group L (28.0% vs. 6.9%, P=0.031). The incidence of anastomosis leakage did not differ between the groups (6.5% vs. 6.9%, P=1.000). However, anastomosis stricture occurred only in group C (13% vs. 0%, P=0.018). Multivariate analysis showed that the anastomosis type was significantly related to the risk of anastomotic complications (P=0.045). Conclusions The overlap method was superior to the HDST with respect to anastomotic complications, especially anastomosis stricture.
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Affiliation(s)
- Ki Bum Park
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Young Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Kyo Young Song
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Identification of c.1531C>T Pathogenic Variant in the CDH1 Gene as a Novel Germline Mutation of Hereditary Diffuse Gastric Cancer. Int J Mol Sci 2019; 20:ijms20204980. [PMID: 31600923 PMCID: PMC6829381 DOI: 10.3390/ijms20204980] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 12/24/2022] Open
Abstract
Germline pathogenic variants in the CDH1 gene are a well-established cause of hereditary diffuse gastric cancer (HDGC) syndrome. The aim of this study was to characterize CDH1 mutations associated with HDGC from Chile, a country with one of the highest incidence and mortality rates in the world for gastric cancer (GC). Here, we prospectively include probands with family history/early onset of diffuse-type of GC. The whole coding sequence of the CDH1 gene was sequenced from genomic DNA in all patients, and a multidisciplinary team managed each family member with a pathogenic sequence variant. Thirty-six cases were included (median age 44 years/male 50%). Twenty-seven (75%) patients had diffuse-type GC at ≤50 years of age and 19 (53%) had first or second-degree family members with a history of HDGC. Two cases (5.5%) carried a non-synonymous germline sequence variant in the CDH1 gene: (a) The c.88C>A missense variant was found in a family with three diffuse-type GC cases; and (b) c.1531C>T a nonsense pathogenic variant was identified in a 22-year-old proband with no previous family history of HDGC. Of note, six family members carry the same nonsense pathogenic variant. Prophylactic gastrectomy in the proband's sister revealed stage I signet-ring cell carcinoma. The finding of 1531C>T pathogenic variant in the CDH1 in proband with no previous family history of HDGC warrants further study to uncover familial clustering of disease in CDH1 negative patients. This finding may be particularly relevant in high incidence countries, such as the case in this report.
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Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, Honda M, Miyata H, Yamashita Y, Seto Y, Kitano S, Konno H. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 2019; 22:202-213. [PMID: 29427039 DOI: 10.1007/s10120-018-0795-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although laparoscopic total gastrectomy (LTG) is considered a technically demanding procedure with safety issues, it has been performed in several hospitals in Japan. Data from a nationwide web-based data entry system for surgical procedures (NCD) that started enrollment in 2011 are now available for analysis. METHODS A retrospective cohort study was conducted using data from 32,144 patients who underwent total gastrectomy and were registered in the NCD database between January 2012 and December 2013. Mortality and morbidities were compared between patients who received LTG and those who underwent open total gastrectomy (OTG) in the propensity score-matched Stage I cohort and Stage II-IV cohort. RESULTS There was no significant difference in mortality rate between LTG and OTG in both cohorts. Operating time was significantly longer in LTG while the blood loss was smaller. In the Stage I cohort, LTG, performed in 33.6% of the patients, was associated with significantly shorter hospital stay but significantly higher incidence of readmission, reoperation, and anastomotic leakage (5.4% vs. 3.6%, p < 0.01). In the Stage II-IV cohort, LTG was performed in only 8.8% of the patients and was associated with significantly higher incidence of leakage (5.7% vs. 3.6%, p < 0.02) although the hospital stay was shorter (15 days vs. 17 days, p < 0.001). CONCLUSION LTG was more discreetly introduced than distal gastrectomy, but remained a technically demanding procedure as of 2013. This procedure should be performed only among the well-trained and informed laparoscopic team.
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Affiliation(s)
- Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Medical and Surgical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Hiroaki Miyata
- Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
| | - Yuichi Yamashita
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yasuyuki Seto
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | | | - Hiroyuki Konno
- Hamamatsu University School of Medicine, Hamamatsu, Japan
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Usefulness of the Transoral Anvil Delivery System for Esophagojejunostomy After Laparoscopic Total Gastrectomy: A Single-institution Comparative Study of Transoral Anvil Delivery System and the Overlap Method. Surg Laparosc Endosc Percutan Tech 2018; 28:e40-e43. [PMID: 29064880 DOI: 10.1097/sle.0000000000000495] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Many reconstruction techniques have been reported after laparoscopic total gastrectomy (LTG), but it is not clear which anastomosis technique is most useful, and no standard methods have been established. This study examined whether LTG using the transoral anvil delivery system (TOADS) is a feasible and safe procedure for gastric cancer. MATERIALS AND METHODS A series of 47 patients underwent the overlap method and 36 underwent the hemi-double-stapling technique with TOADS. Intraoperative and postoperative outcomes were compared between the 2 groups. RESULTS In the TOADS group, operation time for reconstruction was shorter (16±3 vs. 45±10 min, P=0.003), and blood loss was reduced (45±15 vs. 126±13 mL, P=0.0002). There were no significant differences in intraoperative complications, conversion to open surgery, and intraoperative anastomosis-related complications between the 2 groups. Furthermore, there were no significant differences in the incidence of complications, reoperation, mortality, and postoperative hospital stay. CONCLUSION LTG using TOADS for gastric cancer may be a technically feasible surgical procedure with acceptable morbidity.
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Clinical Outcomes of Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy: A Multicenter Study. Surg Laparosc Endosc Percutan Tech 2018; 27:e87-e91. [PMID: 28731955 DOI: 10.1097/sle.0000000000000435] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine the short-term outcomes of intracorporeal anastomosis during totally laparoscopic total gastrectomy retrospectively at multiple institutions. PATIENTS AND METHODS We collected data of the patients who had undergone totally laparoscopic total gastrectomy at 4 institutions. All patients received an intracorporeal esophagojejunostomy. RESULTS Of the 215 patients evaluated, 147 underwent functional end-to-end anastomosis (FEEA) as the intracorporeal esophagojejunostomy (FEEA group), and 68 patients received a circular stapler anastomosis (Circular group). The rate of tumor invasion to the esophagus was significantly higher in the Circular group than in the FEEA group (33% vs. 6%, respectively; P<0.0001). Univariate and multivariate analyses revealed that the circular stapler anastomosis and high preoperative BMI were statistically significant risk factors for postoperative leakage. However, the rates of complications and mortality were not significantly different between groups. CONSIDERATION Our results showed that each type of esophagojejunostomy is safe and feasible for patients with gastric cancer with acceptable morbidity and mortality.
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Huang CJ, Zhang RC, Mou YP, Zhou YC, Wang YY, Lu C, Xu XW. Short and long-term outcomes of laparoscopic total gastrectomy for gastric cancer: A single-center experience (retrospective cohort study). Int J Surg 2018; 51:109-113. [DOI: 10.1016/j.ijsu.2018.01.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 02/07/2023]
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Xu X, Huang C, Mou Y, Zhang R, Pan Y, Chen K, Lu C. Intra-corporeal hand-sewn esophagojejunostomy is a safe and feasible procedure for totally laparoscopic total gastrectomy: short-term outcomes in 100 consecutive patients. Surg Endosc 2017; 32:2689-2695. [PMID: 29101569 DOI: 10.1007/s00464-017-5964-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND An optimal method for intracorporeal esophagojejunostomy has not yet been standardized. This study sought to introduce intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy. METHODS The author conducted a consecutive series of 100 intracorporeal hand-sewn esophagojejunostomies after totally laparoscopic total gastrectomy for upper third gastric cancer from September 2012 to December 2016. RESULTS All patients were successfully operated on without conversion to open- or laparoscope-assisted surgery. The mean reconstruction time was 45 min, and the time until first flatus was 4 days. The time to start a soft diet was 7 days. The length of postoperative hospital stay was 8 days. The overall postoperative morbidity was 8%, including one anastomotic leak, and the mortality was zero. The median follow-up duration was 13 months; no anastomotic strictures were encountered. CONCLUSIONS Intracorporeal hand-sewn end-to-side esophagojejunostomy after totally laparoscopic total gastrectomy is a safe and feasible procedure. This method can identify negative margins with intraoperative frozen sections before reconstruction and could be a good option for performing intracorporeal esophagojejunostomy with an advanced endoscopic suture technique.
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Affiliation(s)
- Xiaowu Xu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Chaojie Huang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Yiping Mou
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China.
| | - Renchao Zhang
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
| | - Yu Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Ke Chen
- School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang, China
| | - Chao Lu
- Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Key Laboratory of Gastroenterology of Zhejiang Province, People's Hospital of Hangzhou Medical College, 158 Shangtang Road, Hangzhou, 310014, Zhejiang, China
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Nakauchi M, Suda K, Nakamura K, Shibasaki S, Kikuchi K, Nakamura T, Kadoya S, Ishida Y, Inaba K, Taniguchi K, Uyama I. Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes. Surg Endosc 2017; 31:4631-4640. [PMID: 28389797 DOI: 10.1007/s00464-017-5526-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/15/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Higher morbidity in total gastrectomy than in distal gastrectomy has been reported, but laparoscopic subtotal gastrectomy (LsTG) has been reported to be safe and feasible in early gastric cancer (GC). We determined the surgical, nutritional and oncological outcomes of LsTG for advanced gastric cancer (AGC). METHODS Of the 816 consecutive patients with GC who underwent radical gastrectomy at our institution between 2008 and 2012, 253 who underwent curative laparoscopic gastrectomy (LG) for AGC were enrolled. LsTG was indicated for patients with upper stomach third tumors, who hoped to avoid total gastrectomy, <4 cm to the esophagogastric junction and a 2-cm proximal margin with cut end negative in frozen section, whereas laparoscopic conventional distal gastrectomy (LcDG) and laparoscopic total gastrectomy (LTG) were performed otherwise. Surgical outcomes and postoperative nutritional status were primarily assessed. RESULTS Of 253 patients, the morbidity (Clavien-Dindo classification grade ≥ III) was 17.0% (43 patients). The 3-year overall survival and 3-year recurrence-free survival rates were 80.2 and 73.5%, respectively. LcDG, LsTG and LTG were performed in 121, 27 and 105 patients, individually. Morbidity was strongly associated with LTG (P = 0.001). Postoperative loss of body weight was significantly greater after LTG in comparison with LcDG or LsTG (P < 0.001). No difference in morbidity and postoperative loss of body weight were observed between LcDG and LsTG group. CONCLUSIONS LG for AGC was feasible and safe surgically and oncologically. LsTG for AGC may be safer than LTG from surgical and postoperative nutritional point of view.
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Affiliation(s)
- Masaya Nakauchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
- Cancer Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kenichi Nakamura
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kenji Kikuchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tetsuya Nakamura
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Shinichi Kadoya
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoshinori Ishida
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Keizo Taniguchi
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, 3-8-3 Mizonokuchi, Takatsu-ku, Kawasaki, 213-8507, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Özer İ, Bostancı EB, Ulaş M, Özoğul Y, Akoğlu M. Changing Trends in Gastric Cancer Surgery. Balkan Med J 2017; 34:10-20. [PMID: 28251018 PMCID: PMC5322507 DOI: 10.4274/balkanmedj.2015.1461] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/21/2016] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer is one of the most common causes of cancer-related death. It requires multimodal treatment and surgery is the most effective treatment modality. Radical surgery includes total or subtotal gastrectomy with lymph node dissection. The extent of lymphadenectomy still remains controversial. Eastern surgeons have performed D2 or more extended lymphadenectomy while their Western colleagues have performed more limited lymph node dissection. However, the trend has been changing in favour of D2 lymph node dissection in both hemispheres. Currently, D2 is the recommended type of lymphadenectomy in experienced centres in the west. In Japan, D2 lymph node dissection is the standard surgical approach. More extensive lymphadenectomy than D2 has not been found to be associated with improved survival and generally is not performed. Bursectomy and splenectomy are additional controversial issues in surgical performance, and trends regarding them will be discussed. The performance of bursectomy is controversial and there is no clear evidence of its clinical benefit. However, a trend toward better survival in patients with serosal invasion has been reported. Routine splenectomy as a part of lymph node dissection has largely been abandoned, although splenectomy is recommended in selected cases. Minimally invasive surgery has gained wide popularity and indications for minimally invasive procedures have been expanding due to increasing experience and improving technology. Neoadjuvant therapy has been shown to have beneficial effects and seems necessary to provide a survival benefit. Diagnostic laparoscopy should be kept in mind prior to treatment.
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Affiliation(s)
- İlter Özer
- Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Erdal Birol Bostancı
- Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Murat Ulaş
- Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Yusuf Özoğul
- Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Musa Akoğlu
- Department of Gastroenterological Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
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26
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Nakauchi M, Suda K, Kadoya S, Inaba K, Ishida Y, Uyama I. Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surg Endosc 2016; 30:4632-4639. [PMID: 26703126 DOI: 10.1007/s00464-015-4726-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/15/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. METHODS A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). RESULTS Early and late morbidities (Clavien-Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278-694) min, 100 (0-2267) g, 48 (16-89), and 23 (9-136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006-1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126-86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328-80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196-8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien-Dindo grade ≥2; [HR 3.670 (1.440-9.351), p = 0.006]. CONCLUSIONS TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.
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Affiliation(s)
- Masaya Nakauchi
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Shinichi Kadoya
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoshinori Ishida
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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27
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Treitl D, Hochwald SN, Bao PQ, Unger JM, Ben-David K. Laparoscopic Total Gastrectomy with D2 Lymphadenectomy and Side-to-Side Stapled Esophagojejunostomy. J Gastrointest Surg 2016; 20:1523-9. [PMID: 27184675 DOI: 10.1007/s11605-016-3162-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/02/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION An optimal method has yet to be established for laparoscopic total gastrectomy with intracorporeal anastomosis. METHODS We aim to describe a simple technique for intracorporeal anastomoses. Technique of laparoscopic total gastrectomy with side-to-side stapled intracorporeal esophagojejunostomy anastomosis and Roux-en-Y jejunojejunostomy is performed on patients with gastric malignancy in an academic community tertiary care center. RESULTS The anastomotic technique of laparoscopic total gastrectomy with side-to-side stapled esophagojejunostomy is described. CONCLUSION Laparoscopic total gastrectomy with D2 lymphadenectomy and side-to-side esophagojejunostomy is safe to perform and has the advantage of a wide lumen with low chance for stricture. A laparoscopic total gastrectomy with stapled side-to-side esophagojejunostomy is feasible and safe in advanced gastric cancer.
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Affiliation(s)
- Daniela Treitl
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Steven N Hochwald
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Philip Q Bao
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Joshua M Unger
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA
| | - Kfir Ben-David
- Mount Sinai Medical Center, Comprehensive Cancer Center, 4306 Alton Road, 2nd Floor, Miami Beach, FL, 33140, USA.
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28
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Kong SH, Dallemagne B. Letter to the Editor Concerning "Short-Term Outcomes of Laparoscopic Total Gastrectomy Performed by a Single Surgeon Experienced in Open Gastrectomy: Review of Initial Experience". J Gastric Cancer 2016; 16:125-7. [PMID: 27430723 PMCID: PMC4944002 DOI: 10.5230/jgc.2016.16.2.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/13/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Korea.; Image-Guided Minimally Invasive Surgical Institute, IHU Strasbourg, France
| | - Bernard Dallemagne
- Research Institute Against Cancer of the Digestive System, Strasbourg, France
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29
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Kwon IG, Son YG, Ryu SW. Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique. J Am Coll Surg 2016; 223:e25-9. [PMID: 27370184 DOI: 10.1016/j.jamcollsurg.2016.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- In Gyu Kwon
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Young-Gil Son
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea.
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30
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Totally Laparoscopic Total Gastrectomy for Gastric Cancer at a Single Institutional Experience and Changes in Technique of Esophagojejunostomy. Indian J Surg 2016; 78:249-53. [PMID: 27358526 DOI: 10.1007/s12262-016-1471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 03/09/2016] [Indexed: 10/22/2022] Open
Abstract
The totally laparoscopic total gastrectomy (TLTG) for gastric cancer has not gained widespread acceptance due to its technical difficulties, especially with the intracorporeal esophagojejunostomy (IEJS). Various modified procedures for the IEJS have been devised, but an optimal method has not yet been standardized. A total of 32 consecutive patients (23 men and 9 women) underwent TLTGs for gastric cancer, between December of 2009 and December of 2014 at the Iwate Medical University Hospital, and were enrolled in this study. Here, we report our institution's experience with TLTGs, with changes in the IEJS. The study participants had a mean age of 66.8 years and a body mass index of 22.8 kg/m2. The mean operation time and blood loss were 356.1 min and 61.2 mL, respectively. According to the IEJS, there were 6 circular stapler (CS) (single and double stapling techniques) and 26 linear stapler (LS) (overlap technique and functional end-to-end anastomosis) procedures performed. Two patients, who had undergone IEJS by double stapling technique, developed anastomotic stenosis and required endoscopic balloon dilatations of the anastomotic sites. Therefore, we changed to LS to secure the abundant anastomotic diameter. In our institute, some problematic complications in the IEJS procedure occurred at the introduction of the TLTG. We have overcome these complications by changing and standardizing the IEJS techniques, and by cultivating the laparoscopic techniques.
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31
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Single-incision laparoscopic sleeve gastrectomy: Is it worth it? Surg Obes Relat Dis 2016; 12:935-936. [PMID: 27134200 DOI: 10.1016/j.soard.2016.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 01/03/2023]
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32
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Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol 2015; 5:238-254. [PMID: 26713285 PMCID: PMC4686422 DOI: 10.5662/wjm.v5.i4.238] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields.
METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria.
RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications.
CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures.
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Kitagami H, Morimoto M, Nakamura K, Watanabe T, Kurashima Y, Nonoyama K, Watanabe K, Fujihata S, Yasuda A, Yamamoto M, Shimizu Y, Tanaka M. Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases. Surg Endosc 2015; 30:4086-91. [PMID: 26701704 DOI: 10.1007/s00464-015-4724-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND We have established a standard procedure for Roux-en-Y (RY) reconstruction in laparoscopic total gastrectomy (LTG) using esophagojejunostomy by the overlap method (OL). We report on our RY reconstruction technique and special approaches, and evaluate the usefulness of our reconstruction method based on the surgical results of 100 patients we have experienced to date. METHODS We performed LTG in 100 patients with gastric cancer. After total gastrectomy using five ports, the resected stomach was extracted through a small laparotomy. Through that, we performed sacrifice of the jejunum, Y limb anastomosis, creation of the lifted jejunum. As the OL, a side-to-side anastomosis of the lifted jejunum to the esophageal stump was laparoscopically performed using a linear stapler in an isoperistaltic direction, and the entry hole was closed with full-thickness suturing. The lifted jejunum was fixed with suture to the duodenal stump at a location where the esophagojejunostomy site was made linear, and the duodenal stump was buried. The mesenteric gap was laparoscopically closed with suture. RESULTS The median operative time in 100 patients undergoing LTG was 385 min, the median blood loss was 65 mL, and the median time required for the OL was 32 min. The mean hospitalization period was 10 days, and postoperative complications included bleeding requiring reoperation in one patient; other complications such as pancreatic fistula in five patients (5 %) were treated conservatively. No complication associated with anastomosis occurred. CONCLUSION In RY reconstruction using the OL, there were no complications associated with the anastomosis site in 100 consecutive patients, such as anastomotic leak or stenosis, indicating that it is a very useful and safe reconstruction method.
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Affiliation(s)
- Hidehiko Kitagami
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
| | - Mamoru Morimoto
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Kenichi Nakamura
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Takahiro Watanabe
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Yo Kurashima
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Keisuke Nonoyama
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Kaori Watanabe
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Shiro Fujihata
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Akira Yasuda
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Minoru Yamamoto
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Yasunobu Shimizu
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Moritsugu Tanaka
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
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34
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Late phase II study of robot-assisted gastrectomy with nodal dissection for clinical stage I gastric cancer. Surg Endosc 2015; 30:3362-7. [DOI: 10.1007/s00464-015-4613-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/30/2015] [Indexed: 12/23/2022]
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