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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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Long VD, Thong DQ, Dat TQ, Nguyen DT, Hai NV, Quoc HLM, Anh NVT, Vuong NL, Bac NH. Risk factors of postoperative complications and their effect on survival after laparoscopic gastrectomy for gastric cancer. Ann Gastroenterol Surg 2024; 8:580-594. [PMID: 38957552 PMCID: PMC11216791 DOI: 10.1002/ags3.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/20/2023] [Accepted: 02/06/2024] [Indexed: 07/04/2024] Open
Abstract
Background The association between postoperative complications and long-term survival after laparoscopic gastrectomy (LG) for gastric cancer (GC) remains uncertain. This study aimed to determine the incidence and risk factors of postoperative complications and evaluate their impact on survival outcomes in patients undergoing LG. Methods A retrospective study was conducted on 621 patients who underwent LG for gastric adenocarcinoma between March 2015 and December 2021. Postoperative complications were classified according to the Clavien-Dindo classification, with major complications defined as Grade III or higher. Logistic regression models with stepwise backward procedure were used to identify risk factors for complications. To assess the impact of postoperative complications on survival, uni- and multi-variable Cox proportional hazard models were used for overall survival (OS) and disease-free survival (DFS). Results Overall rate of postoperative complications was 17.6% (109 patients); 33 patients (5.3%) had major complications. Independent risk factors for major complications were Charlson comorbidities index (OR [95% CI], 1.87 [1.09-3.12], p-value = 0.018 for each one score increase), and type of anastomosis (OR [95% CI], 0.28 [0.09-0.91], p-value = 0.029 when comparing Billroth II with Billroth I). Multivariable analysis identified major complications as an independent prognostic factor to reduce OS (HR [95% CI], 2.32 [1.02-5.30], p-value = 0.045) and DFS (HR [95% CI], 2.63 [1.37-5.06], p-value = 0.004). Other prognostic factors for decreased survival outcomes were tumor size, presence of invasive lymph nodes, and T4a stage. Conclusions Major complications rate of LG for GC was approximately 5.3%. Charlson comorbidities index and type of anastomosis were identified as risk factors for major postoperative complications. Major complications were demonstrated to pose adverse impact on survival outcomes.
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Affiliation(s)
- Vo Duy Long
- Gastro‐intestinal Surgery Department, University Medical CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
- Department of General Surgery, Faculty of MedicineUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Dang Quang Thong
- Gastro‐intestinal Surgery Department, University Medical CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Tran Quang Dat
- Gastro‐intestinal Surgery Department, University Medical CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Doan Thuy Nguyen
- Gastro‐intestinal Surgery Department, University Medical CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Nguyen Viet Hai
- Gastro‐intestinal Surgery Department, University Medical CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Ho Le Minh Quoc
- Gastro‐intestinal Surgery Department, University Medical CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Nguyen Vu Tuan Anh
- Department of General Surgery, Faculty of MedicineUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public HealthUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
| | - Nguyen Hoang Bac
- Gastro‐intestinal Surgery Department, University Medical CenterUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
- Department of General Surgery, Faculty of MedicineUniversity of Medicine and Pharmacy at Ho Chi Minh CityHo Chi Minh CityVietnam
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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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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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Huang ZN, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Lu J, Chen QY, Cao LL, Lin M, Tu RH, Lin JL. Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life. World J Gastroenterol 2017; 23:7129-7138. [PMID: 29093621 PMCID: PMC5656460 DOI: 10.3748/wjg.v23.i39.7129] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/22/2017] [Accepted: 05/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the short-term outcomes and quality of life (QoL) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG). METHODS A total of 507 patients who underwent laparoscopic gastrectomy (D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG (group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy (LATG) (group A, n = 456). The short-term outcomes and QoL were compared between the two groups after 1:2 propensity-score matching (PSM). We used a questionnaire to assess QoL. RESULTS Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups (P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A (P < 0.05). After matching, group T reported better QoL in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better QoL ("Have you felt pain" and "Have you had difficulty eating solid food") (P < 0.05). CONCLUSION The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving QoL after laparoscopic gastrectomy.
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Affiliation(s)
- Ze-Ning Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
| | - Ju-Li Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, Fujian Province, China
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Technical and Survival Risks Associated With Esophagojejunostomy by Laparoscopic Total Gastrectomy for Gastric Carcinoma. Surg Laparosc Endosc Percutan Tech 2017; 27:197-202. [DOI: 10.1097/sle.0000000000000409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Nishimura S, Oki E, Tsutsumi S, Tsuda Y, Sugiyama M, Nakashima Y, Sonoda H, Ohgaki K, Saeki H, Maehara Y. Clinical Significance of Totally Laparoscopic Distal Gastrectomy: A Comparison of Short-term Outcomes Relative to Open and Laparoscopic-assisted Distal Gastrectomy. Surg Laparosc Endosc Percutan Tech 2017; 26:372-376. [PMID: 27552377 DOI: 10.1097/sle.0000000000000308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Laparoscopic distal gastrectomy has become an established minimally invasive treatment for gastric cancer since it was first reported in 1994. MATERIALS AND METHODS We retrospectively assessed the clinical outcomes of 248 patients who had undergone open distal gastrectomy (ODG), laparoscopic-assisted distal gastrectomy (LADG), and totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. RESULTS AND CONCLUSIONS TLDG showed superiority in terms of blood loss, reconstruction options, and postoperative recovery compared with ODG and LADG. Especially, the mean operating time in the TLDG group was significantly shorter than that of the LADG group (P=0.003). Book-binding technique used in TLDG was one of the reasons of this result. The only inferior aspect of TLDG was the longer operating time compared with ODG; TLDG had no disadvantages compared with LADG. Although the operating time and long-term outcome remain problems, we suggest that TLDG has the potential to serve as an optimal operative method.
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Affiliation(s)
- Sho Nishimura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
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Uyama I, Okabe H, Kojima K, Satoh S, Shiraishi N, Suda K, Takiguchi S, Nagai E, Fukunaga T. Gastroenterological Surgery: Stomach. Asian J Endosc Surg 2015; 8:227-238. [PMID: 26303727 DOI: 10.1111/ases.12220] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 12/18/2022]
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Oki E, Tsuda Y, Saeki H, Ando K, Imamura Y, Nakashima Y, Ohgaki K, Morita M, Ikeda T, Maehara Y. Book-Binding Technique for Billroth I Anastomosis During Totally Laparoscopic Distal Gastrectomy. J Am Coll Surg 2014; 219:e69-73. [PMID: 25283741 DOI: 10.1016/j.jamcollsurg.2014.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 08/21/2014] [Accepted: 09/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Yasuo Tsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Ando
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Imamura
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Nakashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kippei Ohgaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaru Morita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tetsuo Ikeda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Gao J, Li P, Li QG, Chen J, Wang DR, Tang D. Comparison between totally laparoscopic and laparoscopically assisted distal gastrectomy for gastric cancer with a short follow-up: a meta-analysis. J Laparoendosc Adv Surg Tech A 2013; 23:693-697. [PMID: 23678885 DOI: 10.1089/lap.2012.0580] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic surgery has become common in the treatment of gastric cancer because of improvements of both surgical techniques and devices. The aim of this study was to compare totally laparoscopic distal gastrectomy (TLDG) with laparoscopically assisted distal gastrectomy (LADG) implemented by experienced laparoscopic surgeons. Studies and relevant literature regarding LADG versus TLDG were searched for in the PubMed and Embase databases. Operative time, volume of bleeding, number of retrieved lymph nodes, time to first flatus, duration of postoperative hospitalization, and postoperative complications in LADG and TLDG were pooled and compared by meta-analysis. Odds ratios (ORs) and weighted mean differences (WMDs) were calculated with 95% confidence intervals (CIs) to evaluate the effect of TLDG. Six recent studies of 1644 patients were included in the meta-analysis. Compared with LADG, TLDG had advantages of less bleeding (WMD -17.79, 95% CI -32.57 to -3.02, P=.02), shorter time to first flatus (WMD -0.14, 95% CI -0.23 to -0.06, P=.001), and shorter postoperative hospitalization (WMD -0.32, 95% CI -0.53 to -0.12, P=.002). Operative time, mean number of lymph nodes retrieved, and postoperative complication rate were not statistically different (P>.05). Compared with LADG, TLDG significantly reduced bleeding, time to first flatus, and postoperative hospital stay and can be considered a useful technique for patients with gastric cancer.
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Affiliation(s)
- Jun Gao
- Department of Gastrointestinal Surgery, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu Province, PR China
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Kim HS, Kim MG, Kim BS, Yook JH, Kim BS. Totally laparoscopic total gastrectomy using endoscopic linear stapler: early experiences at one institute. J Laparoendosc Adv Surg Tech A 2013; 22:889-97. [PMID: 23137114 DOI: 10.1089/lap.2012.0238] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Totally laparoscopic total gastrectomy (TLTG) for gastric cancer is still uncommon because of the technical difficulty of performing the esophagojejunostomy laparoscopically. We have developed a secure technique for intracorporeal esophagojejunostomy and successfully performed the TLTG method using an endoscopic linear stapler. Our experiences with this method are reported here. SUBJECTS AND METHODS Between July 2009 and May 2010, 124 patients with gastric cancer underwent TLTG using endoscopic linear staplers in one institution. The clinicopathological data and surgical outcomes of the first 70 cases and the subsequent 54 cases were reviewed retrospectively and compared because technical improvements were instituted after the 70th case. RESULTS The two groups differed significantly in terms of mean operation time (189.0 versus 148.3 minutes, P<.001), overall postoperative complication rate (37.1% versus 13.0%, P=.003), severe postoperative complication rate (15.7% versus 3.7%, P=.030), and intraoperative event rate (12.9% versus 1.9%, P=.042). CONCLUSIONS The early period of performing TLTG using an endoscopic linear stapler was associated with a high morbidity rate. This improved significantly when key technical changes were introduced. However, surgeons who are inexperienced in laparoscopic gastrectomy should be careful when performing TLTG because it involves many complex processes. The account in this report of our experiences with TLTG may help surgeons to master this method faster and more safely.
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Affiliation(s)
- Hee Sung Kim
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
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Kim HS, Kim MG, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Comparison of Totally Laparoscopic Total Gastrectomy and Laparoscopic-Assisted Total Gastrectomy Methods for the Surgical Treatment of Early Gastric Cancer Near the Gastroesophageal Junction. J Laparoendosc Adv Surg Tech A 2013; 23:204-10. [DOI: 10.1089/lap.2012.0393] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Hee Sung Kim
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Min Gyu Kim
- Department of Surgery, Guri Hospital, Hanyang University School of Medicine, Guri, Korea
| | - Beom Su Kim
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - In Seob Lee
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Sol Lee
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Jeoung Hwan Yook
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
| | - Byung Sik Kim
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
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Kim HS, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Comparison of totally laparoscopic total gastrectomy and open total gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A 2013; 23:323-31. [PMID: 23379920 DOI: 10.1089/lap.2012.0389] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The technique of totally laparoscopic total gastrectomy (TLTG) has been developed for gastric cancer, but its feasibility and surgical outcomes remain unclear. This is the first study comparing the early surgical outcomes of TLTG with those of conventional open total gastrectomy (OTG) for gastric cancer. PATIENTS AND METHODS Between January 2011 and December 2011, 139 patients underwent TLTG, and 207 patients underwent OTG for gastric cancer; surgical procedures were selected by means of preoperative diagnostic tests under T3N2M0. Clinicopathologic characteristics and early surgical outcomes in the two groups were compared retrospectively. RESULTS There were no significant difference in preoperative characteristics between the two groups, and the durations of surgery were not significantly different. However, TLTG was superior to OTG in terms of time to first flatus, time to commencement of soft diet, pain score (visual analog scale), need for analgesics, length of hospital stay, and overall postoperative complications (each P<.05). The median number of lymph nodes harvested was significantly higher in the TLTG group (37 versus 34; P=.039). Resection margins were negative in all patients. CONCLUSIONS TLTG should be considered as a safe and practicable alternative to OTG for the treatment of gastric cancer. Moreover, it is less invasive and results in faster recovery than OTG.
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Affiliation(s)
- Hee Sung Kim
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
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Kim HS, Kim BS, Lee IS, Lee S, Yook JH, Kim BS. Intracorporeal laparoscopic Roux-en-Y gastrojejunostomy after 95% gastrectomy for early gastric cancer in the upper third of the stomach: a report on 21 cases. J Laparoendosc Adv Surg Tech A 2013; 23:250-7. [PMID: 23379919 DOI: 10.1089/lap.2012.0371] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Many reconstructive procedures have been developed in an effort to resolve complications after total gastrectomy (TG). However, anatomical disruption of the esophagogastric junction, especially the low esophageal sphincter, still occurs so that postoperative complications continue to arise. In this study, we developed a procedure for intracorporeal laparoscopic Roux-en-Y gastrojejunostomy (RYGJ) after 95% (near-total) gastrectomy, to reduce postoperative complications in early gastric cancer (EGC) of the upper third of the stomach. PATIENTS AND METHODS Laparoscopic RYGJ after 95% gastrectomy was performed on 21 patients with EGC in the upper third of the stomach between May 2011 and April 2012 in Asan Medical Center, Seoul, Korea. The resection line of the stomach was marked using metallic preoperative endoscopic clips and intraoperative laparascopic vessel clips together with a portable abdominal radiograph. Approximately 95% of the stomach was transected using an endoscopic linear stapler, and an antecolic side-to-side gastrojejunal anastomosis was created between the posterior side of the gastric remnant and the antimesenteric side of the jejunal limb, also using an endoscopic linear stapler. The entry hole was first closed in approximate fashion with three sutures, and closure was completed with an endoscopic linear stapler. RESULTS Intracorporeal laparoscopic RYGJ after 95% gastrectomy was successfully performed in all patients. No patients required conversion to open surgery or other laparoscopic anastomosis techniques. No postoperative complications occurred. All patients had tumor-free resection margins, and there was no mortality. CONCLUSIONS Intracorporeal laparoscopic RYGJ after 95% gastrectomy can be performed easily and safely. We recommend this method over laparoscopic TG or open TG for treatment of EGC in the upper third of the stomach.
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Affiliation(s)
- Hee Sung Kim
- Department of Gastric Surgery, Asan Medical Center, Ulsan University School of Medicine, Seoul, Korea
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Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy: comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis. Surg Endosc 2012; 27:325-32. [PMID: 22733199 PMCID: PMC3532722 DOI: 10.1007/s00464-012-2433-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 05/31/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND Billroth I (B-I) gastroduodenostomy is an anastomotic procedure that is widely performed after gastric resection for distal gastric cancer. A circular stapler often is used for B-I gastroduodenostomy in open and laparoscopic-assisted distal gastrectomy. Recently, totally laparoscopic distal gastrectomy (TLDG) has been considered less invasive than laparoscopic-assisted gastrectomy, and many institutions performing laparoscopic-assisted distal gastrectomy are trying to progress to TLDG without markedly changing the anastomosis method. The purpose of this report is to introduce the technical details of new methods of intracorporeal gastroduodenostomy using either a circular or linear stapler and to evaluate their technical feasibility and safety. METHODS Seventeen patients who underwent TLDG with the intracorporeal double-stapling technique using a circular stapler (n = 7) or the book-binding technique (BBT) using a linear stapler (n = 10) between February 2010 and April 2011 were enrolled in the study. Clinicopathological data, surgical data, and postoperative outcomes were analyzed. RESULTS There were no intraoperative complications or conversions to open surgery in any of the 17 patients. The usual postoperative complications following gastroduodenostomy, such as anastomotic leakage and stenosis, were not observed. Anastomosis took significantly longer to complete with DST (64 ± 24 min) than with BBT (34 ± 7 min), but more stapler cartridges were needed with BBT than with DST. CONCLUSIONS TLDG using a circular or linear stapler is feasible and safe to perform. DST will enable institutions performing laparoscopic-assisted distal gastrectomy with circular staplers to progress to TLDG without problems, and this progression may be more economical because fewer stapler cartridges are used during surgery. However, if an institution has already been performing δ anastomosis in TLDG but has been experiencing certain issues with δ anastomosis, converting from δ anastomosis to BBT should be beneficial.
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