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Kim JC, Lee MJ, Lee HJ, Park K, Kang MK, Kim SH, Zhuang C, Almayouf A, Bernardo MJC, Kim J, Cho YS, Kong SH, Cho SJ, Park DJ, Yang HK. Is Braun Jejunojejunostomy Necessary? Comparison Between Billroth-II Alone and Billroth-II With Braun Anastomosis After Distal Gastrectomy. J Gastric Cancer 2025; 25:318-329. [PMID: 40200875 PMCID: PMC11982509 DOI: 10.5230/jgc.2025.25.e13] [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: 10/06/2024] [Revised: 11/16/2024] [Accepted: 12/02/2024] [Indexed: 04/10/2025] Open
Abstract
PURPOSE The optimal reconstruction method following distal gastrectomy has not been elucidated. Since Billroth-II (B-II) reconstruction is commonly associated with increased bile reflux, Braun jejunojejunostomy has been proposed to reduce this complication. MATERIALS AND METHODS We retrospectively analyzed 325 patients with gastric cancer who underwent distal gastrectomy with B-II reconstruction between January 2015 and December 2017, comprising 159 patients without Braun anastomosis and 166 with Braun anastomosis. Outcomes were assessed over three years using annual gastroscopy based on the residual food, gastritis, and bile reflux criteria and the Los Angeles classification for reflux esophagitis. RESULTS In the first postoperative year, the group with Braun anastomosis showed a significant reduction in bile reflux compared to the group without Braun anastomosis (75.9% vs. 86.2%; P=0.019). Moreover, multivariate analysis identified Braun anastomosis as the sole factor associated with this outcome. Additionally, the group with Braun anastomosis had a lower incidence of heartburn (12.0% vs. 20.1%; P=0.047) and reduced use of prokinetics (P<0.001) and acid reducers (P=0.002) compared to the group without Braun anastomosis. However, these benefits diminished in subsequent years, with no significant differences in residual food, gastritis, or reflux esophagitis between the groups. Both groups showed similar body mass index scores and nutritional outcomes over the 3-year follow-up period. CONCLUSIONS Although Braun anastomosis offers short-term benefits in reducing bile reflux after B-II reconstruction, these effects are not sustainable. The routine use of Braun anastomosis should be reconsidered, though either approach remains a viable option depending on the patient's circumstances.
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Affiliation(s)
- Jane Chungyoon Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Jung Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Kyoyoung Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Kyu Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sa-Hong Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Zhuang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai, China
| | - Abdullah Almayouf
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, King Saud Hospital, Unaizah, Saudi Arabia
| | - Ma Jeanesse C Bernardo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Surgery, Chinese General Hospital and Medical Center, Manila, Philippines
| | - Jeesun Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yo-Seok Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Kim IH, Kang SJ, Choi W, Seo AN, Eom BW, Kang B, Kim BJ, Min BH, Tae CH, Choi CI, Lee CK, An HJ, Byun HK, Im HS, Kim HD, Cho JH, Pak K, Kim JJ, Bae JS, Yu JI, Lee JW, Choi J, Kim JH, Choi M, Jung MR, Seo N, Eom SS, Ahn S, Kim SJ, Lee SH, Lim SH, Kim TH, Han HS. Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline). J Gastric Cancer 2025; 25:5-114. [PMID: 39822170 PMCID: PMC11739648 DOI: 10.5230/jgc.2025.25.e11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2024] [Accepted: 12/24/2024] [Indexed: 01/19/2025] Open
Abstract
Gastric cancer is one of the most common cancers in both Korea and worldwide. Since 2004, the Korean Practice Guidelines for Gastric Cancer have been regularly updated, with the 4th edition published in 2022. The 4th edition was the result of a collaborative work by an interdisciplinary team, including experts in gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology, and guideline development methodology. The current guideline is the 5th version, an updated version of the 4th edition. In this guideline, 6 key questions (KQs) were updated or proposed after a collaborative review by the working group, and 7 statements were developed, or revised, or discussed based on a systematic review using the MEDLINE, Embase, Cochrane Library, and KoreaMed database. Over the past 2 years, there have been significant changes in systemic treatment, leading to major updates and revisions focused on this area. Additionally, minor modifications have been made in other sections, incorporating recent research findings. The level of evidence and grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation system. Key factors for recommendation included the level of evidence, benefit, harm, and clinical applicability. The working group reviewed and discussed the recommendations to reach a consensus. The structure of this guideline remains similar to the 2022 version. Earlier sections cover general considerations, such as screening, diagnosis, and staging of endoscopy, pathology, radiology, and nuclear medicine. In the latter sections, statements are provided for each KQ based on clinical evidence, with flowcharts supporting these statements through meta-analysis and references. This multidisciplinary, evidence-based gastric cancer guideline aims to support clinicians in providing optimal care for gastric cancer patients.
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Affiliation(s)
- In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, The College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea
| | - Wonyoung Choi
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - An Na Seo
- Department of Pathology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Bum Jun Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Busan, Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Jung An
- Division of Oncology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jang Ho Cho
- Division of Medical Oncology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Joon Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jungyoon Choi
- Division of Oncology/Hematology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jwa Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Nieun Seo
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Soo Eom
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Soomin Ahn
- Department of Pathology and Translational Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hee Lim
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
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Xiao S, Ding Z, Zhao F, Yang C, Zhao P, Chen X, Zhou X, Zhou H, Xu R. Patient-reported gastrointestinal symptoms in gastric cancer after laparoscopic distal gastrectomy. Front Oncol 2024; 14:1421643. [PMID: 39540148 PMCID: PMC11557471 DOI: 10.3389/fonc.2024.1421643] [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: 04/22/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose This study aimed to compare postoperative gastrointestinal symptoms between patients who underwent laparoscopic distal gastrectomy with Roux-en-Y (R-Y) and Billroth-II with Braun (B-II B) reconstruction. Methods This observational study retrospectively analyzed 151 patients (110 in R-Y group and 41 in B-II B group) who underwent laparoscopic distal gastrectomy from January 2020 to December 2021. A comparison was made regarding surgical outcomes, perioperative nutritional and inflammatory markers, postoperative dietary patterns, and gastrointestinal symptoms between the two groups. Results The operation time was longer in the R-Y group than the B-II B group (261.00 ± 56.17 min versus 239.88 ± 57.78 min, p = 0.046). However, there were no significant differences in the length of hospital stay, ASA classification, complications, nutritional and inflammatory indexes, or recovery of postoperative diet between the two groups. Additionally, there were no significant differences in the occurrence of postoperative gastrointestinal symptoms in the post-discharge week (PDW) 1 and postoperative month (POM) 1 between the B-II B and R-Y groups. Conclusions Abdominal distention emerged as the main gastrointestinal symptom burden in patients with gastric cancer undergoing laparoscopic distal gastrectomy. Both Billroth-II with Braun and R-Y reconstructions exhibited a high and similar incidence of gastrointestinal symptoms in the short term. Therefore, medical staff should pay attention to the management of gastrointestinal symptoms in these patients postoperatively.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Rui Xu
- Department of Gastric Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
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Thong DQ, Le Minh Quoc H, Dat TQ, Hai NV, Nguyen DT, Tuan Anh NV, Vuong NL, Bac NH, Long VD. Billroth-II modified with hinged anti-peristaltic afferent loop versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer: A propensity-score match analysis. Surgery 2024; 175:1524-1532. [PMID: 38538436 DOI: 10.1016/j.surg.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/11/2024] [Accepted: 02/11/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND This study aimed to evaluate the effectiveness of modified Billroth-II with a hinged anti-peristaltic afferent loop by comparing it with the Roux-en-Y method. METHODS We retrospectively analyzed 344 patients with gastric cancer who underwent distal gastrectomy between 2016 and 2021. Propensity score matching was conducted to balance baseline characteristics. RESULTS After propensity score matching, there were 117 patients in each group. The Billroth-II group was significantly better regarding operating time (184.7 vs 225.3 minutes), postoperative hospital stays (7.9 vs 9.2 days), and time to semi-solid diet tolerance (2.8 vs 3.8 days). The Billroth-II group demonstrated comparable results with the Roux-en-Y group in weight loss, hemoglobin changes, reflux esophagitis, food residue, and gastritis severity. Presentation of bile in gastric remnant was significantly higher in the Billroth-II group (42.9% vs 10.3%). CONCLUSION There were no significant differences in functional outcomes between Billroth-II and Roux-en-Y reconstructions. The Billroth-II was superior to Roux-en-Y in operating time, hospital stays, and time to semi-solid diet tolerance. The Billroth-II could be considered an acceptable alternative reconstruction after distal gastrectomy.
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Affiliation(s)
- Dang Quang Thong
- Department of Gastro-intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho Le Minh Quoc
- Department of Gastro-intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Quang Dat
- Department of Gastro-intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Viet Hai
- Department of Gastro-intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Doan Thuy Nguyen
- Department of Gastro-intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Vu Tuan Anh
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Bac
- Department of Gastro-intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vo Duy Long
- Department of Gastro-intestinal Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Christodoulidis G, Kouliou MN, Koumarelas KE, Argyriou K, Karali GA, Tepetes K. Billroth II anastomosis combined with brown anastomosis reduce reflux gastritis in gastric cancer patients. World J Methodol 2024; 14:89709. [PMID: 38577202 PMCID: PMC10989415 DOI: 10.5662/wjm.v14.i1.89709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/21/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The surgeon performing a distal gastrectomy, has an arsenal of reconstruction techniques at his disposal, Billroth II among them. Braun anastomosis performed during a Billroth II procedure has shown evidence of superiority over typical Billroth II, in terms of survival, with no impact on postoperative morbidity and mortality. AIM To compare Billroth II vs Billroth II and Braun following distal gastrectomy, regarding their postoperative course. METHODS Patients who underwent distal gastrectomy during 2002-2021, were separated into two groups, depending on the surgical technique used (Billroth II: 74 patients and Billroth II and Braun: 28 patients). The daily output of the nasogastric tube (NGT), the postoperative day that NGT was removed and the day the patient started per os feeding were recorded. Postoperative complications were at the same time noted. Data were then statistically analyzed. RESULTS There was difference in the mean NGT removal day and the mean start feeding day. Mean total postoperative NGT output was lower in Braun group (399.17 mL vs 1102.78 mL) and it was statistically significant (P < 0.0001). Mean daily postoperative NGT output was also statistically significantly lower in Braun group. According to the postoperative follow up 40 patient experienced bile reflux and alkaline gastritis from the Billroth II group, while 9 patients who underwent Billroth II and Braun anastomosis were presented with the same conditions (P < 0.05). CONCLUSION There was evidence of superiority of Billroth II and Braun vs typical Billroth II in terms of bile reflux, alkaline gastritis and NGT output.
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Affiliation(s)
| | | | | | - Konstantinos Argyriou
- Department of Gastroenterology, University Hospital of Larissa, Larissa 41334, Greece
| | | | - Konstantinos Tepetes
- Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
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Motamiez A, Maximous D, Salem AAS, Ahmed BM, Kong SH, Park DJ, Lee HJ, Yang HK. Surgical Outcomes of Laparoscopic-assisted Distal Gastrectomy Versus Totally Laparoscopic Distal Gastrectomy Billroth I for Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2024; 34:80-86. [PMID: 38134380 DOI: 10.1097/sle.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis. PATIENTS AND METHODS The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital. RESULTS Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase. CONCLUSION The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.
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Affiliation(s)
- Ahmed Motamiez
- Surgical Oncology Department South Egypt Cancer Institute, Assiut University, Egypt
| | - Doaa Maximous
- Surgical Oncology Department South Egypt Cancer Institute, Assiut University, Egypt
| | - Ahmed A S Salem
- Surgical Oncology Department South Egypt Cancer Institute, Assiut University, Egypt
| | - Badawy M Ahmed
- Surgical Oncology Department South Egypt Cancer Institute, Assiut University, Egypt
| | - Seong-Ho Kong
- Gastrointestinal Surgery Department, Seoul National University Hospital, South Korea
| | - Do Joong Park
- Gastrointestinal Surgery Department, Seoul National University Hospital, South Korea
| | - Hyuk-Joon Lee
- Gastrointestinal Surgery Department, Seoul National University Hospital, South Korea
| | - Han-Kwang Yang
- Gastrointestinal Surgery Department, Seoul National University Hospital, South Korea
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Park SH, Hur H, Park JH, Lee CM, Son YG, Jung MR, Lee HH, Hwang SH, Lee MS, Seo SH, Jeong IH, Son MW, Kim CH, Yoo MW, Oh SJ, Hwang SH, Il Choi S, Choi HS, Keum BR, Yang KS, Park S. Reappraisal of optimal reconstruction after distal gastrectomy - a study based on the KLASS-07 database. Int J Surg 2024; 110:32-44. [PMID: 37755373 PMCID: PMC10793744 DOI: 10.1097/js9.0000000000000796] [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: 05/09/2023] [Accepted: 09/09/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUNDS This study aimed to compare the incidence of bile reflux, quality of life (QoL), and nutritional status among Billroth II (BII), Billroth II with Braun anastomosis (BII-B), and Roux-en-Y (RY) reconstruction after laparoscopic distal gastrectomy (LDG). MATERIALS AND METHODS We reviewed the prospective data of 397 patients from a multicentre database who underwent LDG for gastric cancer between 2018 and 2020 at 20 tertiary teaching hospitals in Korea. Postoperative endoscopic findings, QoL surveys using the European Organization for Research and Treatment of Cancer questionnaire (C30 and STO22), and nutritional and surgical outcomes were compared among groups. RESULTS In endoscopic findings, bile reflux was the lowest in the RY group ( n =67), followed by the BII-B ( n =183) and BII groups ( n =147) at 1 year (3.0 vs. 67.8 vs. 84.4%, all P <0.05). The anti-reflux capability of BII-B was statistically better than that of BII, but not as perfect as that of RY. From the perspective of QoL, BII-B was not inferior to RY, but better than BII reconstruction in causing fewer STO22 reflux symptoms at 6 and 12 months. However, only RY caused fewer C30 nausea symptoms than BII at 6 and 12 months, but not BII-B. Nutritional status and morbidities were similar among the three groups, and the operative time did not differ between the BII-B and RY groups. CONCLUSIONS BII-B cannot substitute for RY in preventing bile reflux, shortening the operative time, or reducing morbidities. Regarding short-term QoL, BII-B was sufficient to reduce STO22 reflux symptoms but failed to reduce C30 nausea symptoms postoperatively.
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Affiliation(s)
- Shin-Hoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon
| | - Jong-Hyun Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
| | - Chang-Min Lee
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Department of Surgery, Korea University Ansan Hospital, Ansan
| | - Young-Gil Son
- Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Han Hong Lee
- Department of Surgery, Catholic University of Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Sun-Hwi Hwang
- Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, Inje University
| | - In Ho Jeong
- Department of Surgery, Jeju National University School of Medicine, Jeju
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan
| | - Chang Hyun Kim
- Department of Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Moon-Won Yoo
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Seong Ho Hwang
- Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Hyuk Soon Choi
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Bo-Ra Keum
- Department of Internal Medicine, Korea University College of Medicine, Seoul
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul
| | - Sungsoo Park
- Division of Foregut Surgery, Korea University College of Medicine, Seoul
- Division of Foregut Surgery, Korea University Anam Hospital, Seoul
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Chen YX, Huang QZ, Wang PC, Zhu YJ, Chen LQ, Wu CY, Wang JT, Chen JX, Ye K. Short- and long-term outcomes of Roux-en-Y and Billroth II with Braun reconstruction in total laparoscopic distal gastrectomy: a retrospective analysis. World J Surg Oncol 2023; 21:361. [PMID: 37990273 PMCID: PMC10664253 DOI: 10.1186/s12957-023-03249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has persisted. Recent studies have demonstrated their efficacy, but the long-term outcomes and postoperative quality of life (QoL) among patients have yet to be evaluated. Therefore, we compared the short-term and long-term outcomes of the two procedures as well as QoL. METHODS The clinical data of 151 patients who underwent total laparoscopic distal gastrectomy (TLDG) at the Gastrointestinal Surgery Department of the Second Hospital of Fujian Medical University from January 2016 to December 2019 were retrospectively analyzed. Of these, 57 cases with Roux-en-Y procedure (R-Y group) and 94 cases with Billroth II with Braun procedure were included (BII + B group). Operative and postoperative conditions, early and late complications, endoscopic outcomes at year 1 and year 3 after surgery, nutritional indicators, and quality of life scores at year 3 postoperatively were compared between the two groups. RESULTS The R-Y group recorded a significantly longer operative time (194.65 ± 21.52 vs. 183.88 ± 18.02 min) and anastomotic time (36.96 ± 2.43 vs. 27.97 ± 3.74 min) compared to the BII + B group (p < 0.05). However, no other significant differences were observed in terms of perioperative variables, including blood loss (p > 0.05). Both groups showed comparable rates of early and late complications. Endoscopic findings indicated similar food residuals at years 1 and 3 post-surgery for both groups. The R-Y group had a lower occurrence of residual gastritis and bile reflux at year 1 and year 3 after surgery, with a statistically significant difference (p < 0.001). Reflux esophagitis was not significantly different between the R-Y and BII + B groups in year 1 after surgery (p = 0.820), but the R-Y group had a lower incidence than the BII + B group in year 3 after surgery (p = 0.023). Nutritional outcomes at 3 years after surgery did not differ significantly between the two groups (p > 0.05). Quality of life scores measured by the QLQ-C30 scale were not significantly different between the two groups. However, on the QLQ-STO22 scale, the reflux score was significantly lower in the R-Y group than in the BII + B group (0 [0, 0] vs. 5.56 [0, 11.11]) (p = 0.003). The rest of the scores were not significantly different (p > 0.05). CONCLUSION Both R-Y and B II + B reconstructions are equally safe and efficient for TLDG. Nevertheless, the R-Y reconstruction reduces the incidence of residual gastritis, bile reflux, and reflux esophagitis, as well as postoperative reflux symptoms, and provides a better quality of life for patients. R-Y reconstruction is superior to BII + B reconstruction for TLDG.
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Affiliation(s)
- Yan-Xin Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Qiao-Zhen Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Peng-Cheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yue-Jia Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Li-Quan Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jin-Tian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jun-Xing Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China.
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9
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Park SH, Man Yoon H, Ryu KW, Kim YW, Han M, Eom BW. Long-term Functional and Patient-reported Outcomes Between Intra-corporeal Delta-shaped Gastroduodenostomy and Gastrojejunostomy After Laparoscopic Distal Gastrectomy. J Gastric Cancer 2023; 23:561-573. [PMID: 37932223 PMCID: PMC10630562 DOI: 10.5230/jgc.2023.23.e35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/29/2023] [Accepted: 09/04/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE This study aimed to compare the long-term functional and patient-reported outcomes between intra-corporeal delta-shaped gastroduodenostomy and gastrojejunostomy after laparoscopic distal gastrectomy for gastric cancer. MATERIALS AND METHODS We retrospectively reviewed clinicopathological data from 616 patients who had undergone laparoscopic distal gastrectomy for stage I gastric cancer between January 2015 and September 2020. Among them, 232 patients who had undergone delta-shaped anastomosis and another 232 who had undergone Billroth II anastomosis were matched using propensity scores. Confounding variables included age, sex, body mass index, physical status classification, tumor location, and T classification. Postoperative complications, nutritional outcomes, endoscopic findings, and quality of life (QoL) were compared between the 2 groups. RESULTS No significant differences in postoperative complications or nutritional parameters between the two groups were observed. Annual endoscopic findings revealed more residual food and less bile reflux in the delta group (P<0.001) than in the Billroth II group. Changes of QoL were significantly different regarding emotional function, insomnia, diarrhea, reflux symptoms, and dry mouth (P=0.007, P=0.002, P=0.013, P=0.001, and P=0.03, respectively). Among them, the delta group had worse insomnia, reflux symptoms, and dry mouth within three months postoperatively. CONCLUSIONS Long-term nutritional outcomes and QoL were comparable between the delta and Billroth II groups. However, more residual food and worse short-term QoL regarding insomnia, reflux symptoms, and dry mouth were observed in the delta group. Longer fasting time before endoscopic evaluation and short-term symptom management would have been helpful for the delta group.
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Affiliation(s)
- Sin Hye Park
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Mira Han
- Biostatistics Collaboration Team, National Cancer Center, Goyang, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea.
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10
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Tsuchiya H, Yasufuku I, Fukada M, Higashi T, Asai R, Sato Y, Tajima JY, Kiyama S, Tanaka Y, Okumura N, Murase K, Takahashi T, Matsuhashi N. Postoperative reflux esophagitis in laparoscopic distal gastrectomy with Billroth-I reconstruction for gastric cancer: Nutritional effect and preoperative risk factors. Asian J Endosc Surg 2023; 16:695-705. [PMID: 37406670 DOI: 10.1111/ases.13225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/24/2023] [Indexed: 07/07/2023]
Abstract
INTRODUCTION Postoperative reflux esophagitis represents a major complication of laparoscopic distal gastrectomy (LDG) with Billroth-I reconstruction (LDGBI). This study aimed to evaluate the nutritional effect and preoperative risk factors of postoperative reflux esophagitis in patients undergoing LDGBI for gastric cancer. METHODS We retrospectively analyzed data of patients with (reflux [+]) and without (reflux [-]) postoperative reflux esophagitis who underwent LDGBI in our institution. Patient backgrounds, surgical outcomes, and perioperative nutritional status were compared. Preoperative risk factors for postoperative reflux esophagitis were also evaluated. RESULTS Between January 2009 and December 2016, 242 patients underwent LDG for gastric cancer. Of these, 218 underwent Billroth-I reconstruction. Seventy-three patients were excluded because of nutritional or oncological reasons. Finally, 23 patients were enrolled as the reflux (+) group and 122 as the reflux (-) group. Although the preoperative/postoperative bodyweight ratio and albumin and hemoglobin values plateaued beyond 6 months postoperatively in the reflux (-) group, these parameters continued to decrease beyond this time in the reflux (+) group. The mean ± SD bodyweight ratios at 3 years postoperatively were 82.83% ± 9.73% and 89.45% ± 8.04% for the reflux (+) and reflux (-) group, respectively (P = .0006). Multivariate analysis revealed that postoperative reflux esophagitis was associated with postoperative body weight loss. Another multivariate analysis revealed preoperative hiatal hernia as an independent predictive factor for postoperative reflux esophagitis. CONCLUSION The risk of reflux esophagitis after LDGBI in patients with hiatal hernia should be considered when deciding therapeutic approaches for such patients.
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Affiliation(s)
- Hiroshi Tsuchiya
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahiro Fukada
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Toshiya Higashi
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ryuichi Asai
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuta Sato
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Jessi Yu Tajima
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shigeru Kiyama
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Naoki Okumura
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Katsutoshi Murase
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takao Takahashi
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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11
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Christodoulidis G, Kouliou MN, Koumarelas KE, Giakoustidis D, Athanasiou T. Quality of Life in Patients Undergoing Surgery for Upper GI Malignancies. Life (Basel) 2023; 13:1910. [PMID: 37763313 PMCID: PMC10532582 DOI: 10.3390/life13091910] [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: 08/03/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Upper gastrointestinal (GI) conditions vastly affect each individual's physical, social, and emotional status. The decision-making process by the medical personnel about these patients is currently based on a patient's life quality evaluation scale, HRQL scales. By utilizing HRQL scales, a better understanding of the various surgical and non-surgical treatment options, as well as their long-term consequences, can be achieved. In our study, an organ-based approach is used in an attempt to examine and characterized the effect of upper GI surgery on HRQL. Therefore, HRQL scales' function as a prognostic tool is useful, and the need for future research, the creation of valid training programs, and modern guidelines is highlighted.
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Affiliation(s)
- Grigorios Christodoulidis
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Marina-Nektaria Kouliou
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Konstantinos-Eleftherios Koumarelas
- Department of General Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece; (M.-N.K.); (K.-E.K.)
| | - Dimitris Giakoustidis
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, 56429 Thessaloniki, Greece;
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, University Hospital of Larissa, University of Thessaly, Biopolis, 41110 Larissa, Greece;
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12
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Wu Z, Zhou ZG, Li LY, Gao WJ, Yu T. Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer: A prospective case-control study. World J Gastrointest Surg 2023; 15:1354-1362. [PMID: 37555119 PMCID: PMC10405104 DOI: 10.4240/wjgs.v15.i7.1354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Gastric cancer is the most common cause of cancer-related deaths, and is classified according to its location in the proximal, middle, or distal stomach. Surgical resection is the primary approach for treating gastric cancer. This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer. AIM To explore the efficacy of different staplers and digestive tract reconstruction (DTR) methods after radical gastrectomy and their influence on prognosis. METHODS Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study, with a follow-up period of 12-26 mo. The patients were assigned to four groups based on the stapler and DTR plan as follows: Billroth Ⅰ (B-I) reconstruction + linear stapler group (group A, 22 cases), B-I reconstruction + circular stapler group (group B, 22 cases), Billroth II (B-II) reconstruction + linear stapler group (group C, 22 cases), and B-II reconstruction + circular stapler group (group D, 21 cases). The pathological parameters, postoperative gastrointestinal function recovery, postoperative complications, and quality of life (QOL) were compared among the four groups. RESULTS No significant differences in the maximum diameter of the gastric tumors, total number of lymph nodes dissected, drainage tube removal time, QLQ (QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively, and incidence of complications were observed among the four groups (P > 0.05). However, groups A and C (linear stapler) had significantly lower intraoperative blood loss and significantly shorter anastomosis time, operation time, first fluid diet intake time, first exhaust time, and length of postoperative hospital stay (P < 0.05) than groups B and D (circular stapler). CONCLUSION Linear staplers offer several advantages for postoperative recovery. B-I and B-II reconstruction methods had similar effects on QOL. The optimal solution can be selected according to individual conditions and postoperative convenience.
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Affiliation(s)
- Zhen Wu
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Zhi-Gang Zhou
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Ling-Yu Li
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Wen-Jing Gao
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
| | - Ting Yu
- Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China
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13
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Yang K, Zhang W, Chen Z, Chen X, Liu K, Zhao L, Hu J. Comparison of long-term quality of life between Billroth-I and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a randomized controlled trial. Chin Med J (Engl) 2023; 136:1074-1081. [PMID: 37014767 PMCID: PMC10228481 DOI: 10.1097/cm9.0000000000002602] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer. METHODS A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group ( N = 70) and R-Y group ( N = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied. RESULTS The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs . 88.8 ± 16.1, P = 0.033; postoperative 3 year: 87.3 ± 15.2 vs . 92.8 ± 11.3, P = 0.028; postoperative 5 year: 90.9 ± 13.7 vs . 96.4 ± 5.6, P = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs . 2.8 ± 5.3, P = 0.001; postoperative 5 year: 5.1 ± 9.8 vs . 1.8 ± 4.7, P = 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P = 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P = 0.006; postoperative 5 year: 6.0 ± 8.9 vs . 2.7 ± 4.6, P = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points. CONCLUSIONS Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR-TRC-10001434.
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Affiliation(s)
- Kun Yang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weihan Zhang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zehua Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaolong Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Kai Liu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Linyong Zhao
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiankun Hu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Yoshikawa K, Shimada M, Tokunaga T, Nakao T, Nishi M, Takasu C, Kashihara H, Wada Y, Yoshimoto T. Stapler insertion angle toward the esophagus reduces the incidence of early postoperative Roux stasis syndrome after distal gastrectomy in minimally invasive surgery. BMC Surg 2023; 23:54. [PMID: 36906525 PMCID: PMC10007757 DOI: 10.1186/s12893-023-01954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/06/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND Roux stasis syndrome (RSS) after Roux-en-Y (RY) reconstruction significantly prolongs the hospital stay and decreases the quality of life. The purpose of the present study was to evaluate the incidence of RSS in patients who underwent distal gastrectomy for gastric cancer and to identify the factors related to the development of RSS after mechanical RY reconstruction in minimally invasive surgery (MIS). METHODS This study included 134 patients who underwent distal gastrectomy in MIS with mechanical RY anastomosis. RSS was defined as the presence of symptoms such as nausea, vomiting, or abdominal fullness, and the confirmation of delayed gastric emptying on imaging or gastrointestinal fiber testing. Clinical data were checked, including body mass index, operative procedure, age, sex, operative time, blood loss volume, extent of lymph node dissection, final stage, stapler insertion angle, method of entry hole closure. The relationship between the incidence of RSS and these factors was analyzed. RESULTS RSS occurred in 24 of 134 patients (17.9%). RSS occurred significantly more frequently in patients with D2 lymphadenectomy than in patients with D1 + lymphadenectomy (p = 0.04). All patients underwent side-to-side anastomosis via the antecolic route. The incidence of RSS was significantly greater in patients with a stapler insertion angle toward the greater curvature (n = 20, 22.5%) versus the esophagus (n = 4, 8.9%) (p = 0.04). The multivariate logistic regression model revealed that the stapler insertion angle to the greater curvature is identified as independent risk factor for RSS (OR 3.23, 95%Cl 1.01-10.3, p = 0.04). CONCLUSION Stapler insertion angle toward the esophagus may reduce the incidence of early postoperative RSS rather than toward the greater curvature.
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Affiliation(s)
- Kozo Yoshikawa
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan.
| | - Mitsuo Shimada
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Takuya Tokunaga
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Toshihiro Nakao
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Masaaki Nishi
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Chie Takasu
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Hideya Kashihara
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Yuma Wada
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
| | - Toshiaki Yoshimoto
- The Department of Surgery, The University of Tokushima, 3-18-15 Kuramoto-cho, Kuramoto-Cho, Tokushima, 770-8503, Japan
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15
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The impact of the 30-day postoperative complications on the quality of life following gastrectomy for gastric carcinoma: A prospective study. Eur J Surg Oncol 2023; 49:983-989. [PMID: 36682945 DOI: 10.1016/j.ejso.2023.01.017] [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: 11/30/2022] [Revised: 01/02/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The effect of postoperative complications on long-term quality of life (QoL) is controversial in abdominal surgery. This study aimed to investigate the impact of 30-day postoperative complications on long-term QoL after gastrectomy. METHOD This is a longitudinal cohort study that enrolled 908 patients undergoing gastrectomy for gastric cancer between 2016 and 2017. QoL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) generic cancer (QLQ C-30) and gastric module (STO-22) preoperatively and at 1, 6, 12, and 24 months postoperatively. Patients were divided into the morbidity (30-day postoperative complications) and no-morbidity groups, and the postoperative QoL change was compared using a linear mixed model. RESULTS The mean age was 62.5 ± 12.0 years. Subtotal and total gastrectomy was performed in 763 (84.0%) and 145 (16.0%) patients, respectively. There were 189 (20.8%) patients developing postoperative complications. The morbidity group showed worse scores in several functions and symptoms of QoL at the baseline. However, the two groups showed no significant difference in postoperative changes in most functions and symptoms of the QLQ C-30 and STO-22 (Pgroup × time > 0.05). The recovery of global health (Pgroup × time < 0.001) and anxiety (Pgroup × time = 0.008) was slightly better in the morbidity group. The subgroup analysis of patients developing major abdominal complications showed similar results. CONCLUSION The morbidity group showed worse QoL in several functions and symptoms at the baseline. However, postoperative complications had little influence on QoL change following gastrectomy for gastric cancer.
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Kim TH, Kim IH, Kang SJ, Choi M, Kim BH, Eom BW, Kim BJ, Min BH, Choi CI, Shin CM, Tae CH, Gong CS, Kim DJ, Cho AEH, Gong EJ, Song GJ, Im HS, Ahn HS, Lim H, Kim HD, Kim JJ, Yu JI, Lee JW, Park JY, Kim JH, Song KD, Jung M, Jung MR, Son SY, Park SH, Kim SJ, Lee SH, Kim TY, Bae WK, Koom WS, Jee Y, Kim YM, Kwak Y, Park YS, Han HS, Nam SY, Kong SH. Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach. J Gastric Cancer 2023; 23:3-106. [PMID: 36750993 PMCID: PMC9911619 DOI: 10.5230/jgc.2023.23.e11] [Citation(s) in RCA: 156] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/09/2023] Open
Abstract
Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.
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Affiliation(s)
- Tae-Han Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joo Kang
- Department of Internal Medicine, Seoul National University Hospital Healthcare System Gangnam Center Seoul, Seoul, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency (NECA), Seoul, Korea
| | - Baek-Hui Kim
- Department of Pathology, Korea University Guro Hospital, Seoul, Korea
| | - Bang Wool Eom
- Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Anyang, Korea
| | - Byung-Hoon Min
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Chang In Choi
- Department of Surgery, Pusan National University Hospital, Pusan, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seungnam, Korea
| | - Chung Hyun Tae
- Department of Internal Medicine, Ewha Woman's University College of Medicine, Seoul, Korea
| | - Chung Sik Gong
- Division of Gastrointestinal Surgery, Department of Surgery, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Eun Jeong Gong
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Geum Jong Song
- Department of Surgery, Soonchunhyang University, Cheonan, Korea
| | - Hyeon-Su Im
- Department of Hematology and Oncology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hye Seong Ahn
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyun Lim
- Department of Gastroenterology, Hallym University Sacred Heart Hospital, University of Hallym College of Medicine, Anyang, Korea
| | - Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University, College of Medicine, Incheon, Korea
| | - Ji Yeon Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jwa Hoon Kim
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Minkyu Jung
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Shin-Hoo Park
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Soo Jin Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Sung Hak Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Woo Kyun Bae
- Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Yeseob Jee
- Department of Surgery, Dankook University Hospital, Cheonan, Korea
| | - Yoo Min Kim
- Department of Surgery, Severance Hospital, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Young Suk Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Sook Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea.
| | - Su Youn Nam
- Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital and Seoul National University College of Medicine Cancer Research Institute, Seoul, Korea.
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17
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Chen G, Cheng L, Liu L, Luo G, Li M, Wen Y, Wang T, Cao Y. Comparison of gastric-jejunum pouch anastomosis and Billroth-II reconstructions after distal gastrectomy: a propensity score matching analysis. Ann Surg Treat Res 2022; 103:81-86. [PMID: 36017143 PMCID: PMC9365644 DOI: 10.4174/astr.2022.103.2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Our study aimed to make a propensity score matching (PSM) analysis on the clinical application of gastric-jejunum pouch anastomosis (GJPA) and Billroth-II anastomosis after distal gastrectomy. Methods We collected clinical data from 249 patients who received distal gastrectomy from January 2016 to July 2020. According to the reconstruction method used, all patients were divided into the Billroth-II group and the GJPA group. Clinical data and operation complications were analyzed. Results The clinical characteristics of the 2 groups were comparable after PSM. In the Billroth-II group, the incidence rate of delayed gastric emptying was higher than that in the GJPA group. Fewer patients suffered reflux gastritis in the GJPA group. The RGB (residue, gastritis, and bile) scores related to the severity of bile reflux into the remnant stomach, gastritis, and residue were higher in the Billroth-II group. Postoperative nutritional status and Visick classification demonstrated that postoperative subjective feelings in the GJPA group were improved significantly. Conclusion The application of GJPA in reconstruction after distal gastrectomy is safe, economical, and reliable. This reconstruction improved the quality of life of patients. It is worth popularizing widely in clinical settings.
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Affiliation(s)
- Guangyu Chen
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Long Cheng
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Liye Liu
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Guode Luo
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Ming Li
- Western Theater Command Center for Disease Control and Prevention, Chengdu, China
| | - Yi Wen
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Tao Wang
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
| | - Yongkuan Cao
- General Surgery Center, The General Hospital of Western Theater Command, Chengdu, China
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18
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Li XG, Song QY, Wu D, Li S, Zhang BL, Zhang LY, Guan D, Wang XX, Liu L. Does the addition of Braun anastomosis to Billroth II reconstruction on laparoscopic-assisted distal gastrectomy benefit patients? World J Gastrointest Oncol 2022; 14:1141-1147. [PMID: 35949212 PMCID: PMC9244985 DOI: 10.4251/wjgo.v14.i6.1141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Operation is the primary therapeutic option for patients with distal gastrectomy. Braun anastomosis is usually performed after Billroth II reconstruction, which is wildly applied on distal gastrectomy because it is believed to benefit patients. However, studies are needed to confirm that. AIM To identify whether the addition of Braun anastomosis to Billroth II reconstruction on laparoscopy-assisted distal gastrectomy benefits patients. METHODS A total of 143 patients with gastric cancer underwent laparoscopy-assisted distal gastrectomy at Centre 1 of PLA general hospital between January 2015 and December 2019. Clinical data of the patients were collected, and 93 of the 143 patients were followed up. These 93 patients were divided into two groups: Group 1 (Billroth II reconstruction, 33 patients); and Group 2 (Billroth II reconstruction combined with Braun anastomosis, 60 patients). Postoperative complication follow-up data and relevant clinical data were compared between the two groups. RESULTS There were no significant differences between Group 1 and Group 2 in postoperative complications (6.1% vs 6.7%, P = 0.679), anal exhaust time or blood loss. The follow-up prevalence of reflux gastritis indicated no significant difference between Group 1 and Group 2 (68.2% vs 51.7%, P = 0.109). The follow-up European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 scores revealed no evident difference between Group 1 and Group 2 as well. Group 1 had a shorter operating time than Group 2 on average (234.6 min vs 262.0 min, P = 0.017). CONCLUSION Combined with Billroth II reconstruction, Braun anastomosis has been applied due to its ability to reduce the prevalence of reflux gastritis. Whereas in this study, the prevalence of reflux gastritis showed no significant difference, leading to a conclusion that under the circumstance of Braun anastomosis costing more time and more money, simple Billroth II reconstruction should be widely applied.
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Affiliation(s)
- Xiong-Guang Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Ying Song
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Di Wu
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Li
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ben-Long Zhang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Yu Zhang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Da Guan
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Lu Liu
- Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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19
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Chung JH, Im DW, Choi CW, Kim SJ, Hwang SH, Lee SH. A 3-year follow-up study of uncut Roux-en-Y reconstruction: clinical results and outcomes. Surg Endosc 2022; 36:7588-7596. [DOI: 10.1007/s00464-022-09198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
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20
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Yalikun A, Ma J, Zheng M, Zang L. ASO Author Reflections: Totally Laparoscopic Distal Gastrectomy with Modified Billroth-II with Braun Reconstruction Could Be Technically Feasible and Effective in Preventing Bile Reflux. Ann Surg Oncol 2022; 29:2368-2369. [PMID: 34994891 DOI: 10.1245/s10434-021-11228-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Abudushalamu Yalikun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,Shanghai Minimally Invasive Surgery Center, Shanghai, China.
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21
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Min JS, Kim RB, Seo KW, Jeong SH. Comparison of the Clinical Outcomes of Reconstruction Methods After Distal Gastrectomy: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials. J Gastric Cancer 2022; 22:83-93. [PMID: 35534446 PMCID: PMC9091459 DOI: 10.5230/jgc.2022.22.e9] [Citation(s) in RCA: 3] [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: 01/18/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To analyze the short- and long-term clinical outcomes of 2 reconstruction methods after distal gastrectomy for gastric cancer. METHODS Three keywords, "gastric neoplasm," "distal gastrectomy," and "reconstruction," were used to search PubMed. We selected only randomized controlled trial that compared the anastomosis methods. A total of 11 papers and 8 studies were included in this meta-analysis. All statistical analyses were performed using the R software. RESULTS Among short-term clinical outcomes, a shorter operation time, reduced morbidity, and shorter hospital stay were found for Billroth type I (B-I) than for Roux-en-Y (RNY) reconstruction in the meta-analysis (P<0.001, P=0.048, P<0.001, respectively). When comparing Billroth type II (B-II) to RNY, the operation time was shorter for B-II than for RNY (P<0.019), but there were no differences in morbidity or length of hospital stay (P=0.500, P=0.259, respectively). Regarding long-term clinical outcomes related to reflux, there were significantly fewer incidents of reflux esophagitis, reflux gastritis, and bile reflux (P=0.035, P<0.001, P=0.019, respectively) for RNY than for B-I in the meta-analysis, but there was no difference between the 2 methods in residual food (P=0.545). When comparing B-II to RNY, there were significantly fewer incidents of reflux gastritis (P<0.001) for RNY than for B-II, but the amount of residual food and patient weight gain showed no difference. CONCLUSION B-I had the most favorable short-term outcomes, but RNY was more advantageous for long-term outcomes than for other methods. Surgeons should be aware of the advantages and disadvantages of each type of anastomosis and select the appropriate method.
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Affiliation(s)
- Jae-Seok Min
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Center, Busan, Korea
| | - Rock Bum Kim
- Regional Cardiocerebrovascular Disease Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Kyung Won Seo
- Department of Surgery, Kosin University Gospel Hospital, Busan, Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea.
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22
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Satisfaction with permanent changes after cancer surgery: From personal satisfaction of gastric cancer survivors with post-gastrectomy weight loss. Asian J Surg 2022; 45:2706-2712. [PMID: 35367097 DOI: 10.1016/j.asjsur.2021.11.067] [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: 06/14/2021] [Revised: 09/15/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND This study assessed the personal satisfaction of gastric cancer survivors with post-gastrectomy weight loss. The responses were analyzed in relation to the actual weight status based on two general criteria-preoperative weight and the World Health Organization (WHO) weight classification-as part of an attempt to identify patterns of satisfaction with weight loss. METHODS Survivors with significant postoperative weight loss (≥8%) were identified among 1- and 5-year survivors, and were divided into obese/non-obese weight losers (WLs) based on the WHO definition of obesity. For comparison, those with minimal weight change (not exceeding ± 3%) at each time period were identified (non-WLs).The EORTC QLQ-C30 and -STO22 questionnaires were used to monitor quality of life (QoL). Responses to an item in the EORTC QLQ-STO22, inquiring about personal concerns with weight loss, were used to assess personal satisfaction with weight changes. RESULTS Except for the QoL disadvantages of non-obese WLs in anxiety (P = 0.011) of 1-year survivors and in emotional functioning (P = 0.039) of 5-year survivors, there was no significant difference in QoL changes between groups. Regarding personal satisfaction with decreased body weight, non-obese WLs continued to show dissatisfaction (P < 0.001) unlike obese WLs, who enjoyed satisfaction comparable to non-WLs long after surgery. CONCLUSION Compared with non-obese WLs who expressed dissatisfaction with current weight, obese WLs were satisfied with their current weight several years after surgery. Patient satisfaction with surgical changes may depend on the availability of reasonable grounds that suggest a positive interpretation of surgically altered status.
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23
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Chen G, Wu J, Zhang H, Wen Y, Luo G, Chen Z, Zhou J, Cao Y. Addition of Jejunal Lateral Anastomosis is Not Necessary for Gastric-Jejunum Pouch Anastomosis following Distal Gastrectomy: A Propensity-Score Matching Analysis. J INVEST SURG 2022; 35:1263-1268. [PMID: 35236193 DOI: 10.1080/08941939.2022.2032489] [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: 10/19/2022]
Abstract
PURPOSE To make a propensity-score matching analysis on the clinical application of gastric-jejunum pouch anastomosis (GJPA) and continuous jejunal pouch and residual stomach anastomosis combined with jejunal lateral anastomosis (Contin-L). METHODS The clinic data of 287 patients who received distal gastrectomy from January 2015 to January 2019 were collected retrospectively. The enrolled patients were divided into the GJPA group and the Contin-L group according to the reconstruction method used. Clinical data and operation complications were analyzed. RESULTS Compared with Contin-L group, the duration of digestive tract reconstruction in the GJPA group was shorter, and the overall cost in the GJPA group was lower. No obvious intergroup differences were found in other intraoperative data, early surgical outcomes, incidence rates of reflux gastritis, anastomotic ulcer, postoperative nutritional and hematological indicators. The postoperative subjective feelings in the GJPA group were similar with those in the Contin-L groups. CONCLUSION Addition of jejunal lateral anastomosis is not necessary for GJPA following distal gastrectomy.
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Affiliation(s)
- Guangyu Chen
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Wu
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Hengdi Zhang
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Yi Wen
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Guode Luo
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Zhenyu Chen
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Zhou
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Yongkuan Cao
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
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24
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Billroth II anastomosis maintains SMI and BMI better than Roux-en-Y anastomosis following totally laparoscopic distal gastrectomy: a propensity score-matched study. Langenbecks Arch Surg 2022; 407:1441-1450. [DOI: 10.1007/s00423-022-02459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
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25
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Kumagai K, Lee SW, Ohira M, Aizawa M, Kamiya S, Takahata T, Toda M, Cho H, Takahashi M, Kubota T, Kinami S, Kosaka T. Time interval after various types of gastrectomy until metachronous multiple gastric cancer: Analysis of data from a nationwide Japanese survey. Mol Clin Oncol 2022; 16:54. [PMID: 35070303 PMCID: PMC8764660 DOI: 10.3892/mco.2021.2487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022] Open
Abstract
The factors influencing the time interval from the initial surgery for gastric cancer to the detection of metachronous multiple gastric cancer (MMGC) remain to be elucidated. The present study was performed to evaluate the association between the type of initial gastrectomy or reconstruction procedure and the time interval from initial gastrectomy to the detection of MMGC. A questionnaire survey on remnant stomach cancer was performed by the Japanese Society for Gastro-Surgical Pathophysiology in 2018. Participating facilities were requested to indicate the number of patients who underwent surgery for MMGC between 2003 and 2017, in association with the time interval from the initial gastrectomy until treatment for MMGC by type of initial gastrectomy or reconstruction procedure. Analyses were performed using data from 45 facilities. Gastrectomy for MMGC was performed on 1,234 patients during this period. Pylorus-preserving gastrectomy (PPG) accounted for only 3.6% (20/557) of the patients who underwent surgery for MMGC ≥10 years from initial gastrectomy, while PPG accounted for 10.1% (40/396) of patients who underwent surgery for MMGC within 5 years after initial gastrectomy. Billroth-II and Roux-en Y reconstruction accounted for 22.3% (103/462) and 1.3% (6/462), respectively, of patients who underwent surgery for MMGC ≥10 years from initial distal gastrectomy (DG), while such patients accounted for 8.0% (23/286) and 21.7% (65/286), respectively, of patients who underwent surgery for MMGC within 5 years after initial DG. Similarly, the proportion of each reconstruction procedure differed according to the time interval from initial proximal gastrectomy to treatment for MMGC. The types of gastrectomy or reconstruction procedure for initial gastrectomy differed significantly according to the time interval between the initial gastrectomy and treatment for MMGC, and the fact that PPG and R-Y reconstruction in DG is a relatively new method were assumed to be a major cause of these differences.
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Affiliation(s)
- Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo 135-8550, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical College, Osaka 569-8686, Japan
| | - Masaichi Ohira
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka 558-8585, Japan
| | - Masaki Aizawa
- Department of Digestive Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Satoshi Kamiya
- Department of Gastric Surgery, Shizuoka Cancer Center, Sunto, Shizuoka 411-8777, Japan
| | - Takaomi Takahata
- Department of Surgery, Okayama Saiseikai General Hospital, Kita-ku, Okayama 700-8511, Japan
| | - Makoto Toda
- Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata 990-2214, Japan
| | - Haruhiko Cho
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo 113-8677, Japan
| | - Masazumi Takahashi
- Department of Surgery, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa 221-0855, Japan
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, Uchinada, Ishikawa 920-0293, Japan
| | - Takeo Kosaka
- Department of Surgical Oncology, Kanazawa Medical University, Uchinada, Ishikawa 920-0293, Japan
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Lombardo F, Aiolfi A, Cavalli M, Mini E, Lastraioli C, Panizzo V, Lanzaro A, Bonitta G, Danelli P, Campanelli G, Bona D. Techniques for reconstruction after distal gastrectomy for cancer: updated network meta-analysis of randomized controlled trials. Langenbecks Arch Surg 2022; 407:75-86. [PMID: 35094151 DOI: 10.1007/s00423-021-02411-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The choice of the best reconstruction technique after distal gastrectomy (DG) remains controversial and still not defined. The purpose was to perform a comprehensive evaluation within the major type of intestinal reconstruction after DG for gastric cancer. METHODS Systematic review and network meta-analyses of randomized controlled trials (RCTs) to compare Billroth I (BI), Billroth II (BII), Billroth II Braun (BII Braun), Roux-en-Y (RY), and Uncut Roux-en-Y (URY). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures while 95% credible intervals (CrI) were used to assess relative inference. RESULTS Ten RCTs (1456 patients) were included. Of these, 448 (33.7%) underwent BI, 220 (15.1%) BII, 114 BII Braun (7.8%), 533 (36.6%) RY, and 141 URY (9.6%). No significant differences were found among treatments for 30-day mortality, anastomotic leak, anastomotic stricture, and overall complications. At 12-month follow-up, RY was associated with a significantly reduced risk of remnant gastritis compared to BI (RR=0.56; 95% Crl 0.35-0.76) and BII reconstruction (RR=0.47; 95% Crl 0.22-0.97). Similarly, despite the lack of statistical significance, RY seems associated with a trend toward reduced endoscopically proven esophagitis compared to BI (RR=0.58; 95% Crl 0.24-1.51) and bile reflux compared to BI (RR=0.48; 95% Crl 0.17-1.41), BII (RR=0.74; 95% Crl 0.20-2.81), and BII Braun (RR=0.65; 95% Crl 0.30-1.43). CONCLUSIONS This network meta-analysis shows that there are five main options for intestinal anastomosis after DG. All techniques seem equally safe with comparable anastomotic leak, anastomotic stricture, overall morbidity, and short-term outcomes. In the short-term follow-up (12 months), RY seems associated with a reduced risk of remnant gastritis and a trend toward a reduced risk of bile reflux and esophagitis.
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Affiliation(s)
- Francesca Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Alberto Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - Marta Cavalli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Emanuele Mini
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Caterina Lastraioli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Valerio Panizzo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Alessio Lanzaro
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Gianluca Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Piergiorgio Danelli
- Department of Biomedical and Clinical Sciences, "Luigi Sacco" Hospital, University of Milan, Milan, Italy
| | - Giampiero Campanelli
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - Davide Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
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27
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Yalikun A, Aikemu B, Li S, Zhang T, Ma J, Zheng M, Zang L. A Modified Billroth-II with Braun Anastomosis in Totally Laparoscopic Distal Gastrectomy: Initial Experience Compared with Roux-en-Y Anastomosis. Ann Surg Oncol 2022; 29:2359-2367. [PMID: 34994886 DOI: 10.1245/s10434-021-11187-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND This retrospective study aimed to compare the feasibility and effectiveness of a modified Billroth-II with Braun (B-II Braun) reconstruction and those of a Roux-en-Y (R-Y) reconstruction after laparoscopic distal gastrectomy. METHODS From January 2016 to December 2019, 247 patients underwent total laparoscopic distal gastrectomy (TLDG), with B-II Braun reconstruction for 145 patients and R-Y reconstruction for 102 patients. The patients' data were collected prospectively and reviewed retrospectively. RESULTS In this study, the median times of the operation were statistically shorter for B-II Braun than for R-Y (167 min [range, 110-331 min] vs 191 min [range, 123-384 min]; p = 0.001), including anastomotic times (33 min [range, 30-42 min] vs 42 min [range, 40-48 min]; p = 0.001). After a short-term follow-up period, endoscopy showed 31 cases of bile reflux (21.4%), 15 cases of grade 2 gastritis (10.3%), and 6 cases of grade 2 food residue (4.1%) in the B-II Braun group after 6 months. After 1 year, 10 patients (6.9%) had grade 2 gastritis and 2 patients (1.4%) had grade 3 gastritis. However, the remnant stomach of the two groups did not differ significantly in the rate of gastric residue (p = 0.112 after 6 months; p = 0.579 after 1 year, respectively), gastritis (p = 0.726 after 6 months; p = 0.261 after 1 year, respectively), or bile reflux (p = 0.262 after 6 months; p = 0.349 after 1 year, respectively). CONCLUSIONS For gastric cancer patients, TLDG with modified B-II Braun reconstruction could be technically feasible. It has an acceptable range of postoperative complications and is effective in preventing bile reflux into the gastric remnant.
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Affiliation(s)
- Abudushalamu Yalikun
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Batuer Aikemu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Shuchun Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Tao Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Minimally Invasive Surgery Center, Shanghai, China
| | - Junjun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai Minimally Invasive Surgery Center, Shanghai, China.
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Yüksel C, Çulcu S. New learning area in laparoscopic gastrectomy for gastric cancer: YouTube® or WebSurg®? J Minim Access Surg 2022; 18:129-135. [PMID: 35017403 PMCID: PMC8830580 DOI: 10.4103/jmas.jmas_300_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Laparoscopic gastrectomy cannot be performed routinely in many centres, because there is still no standardisation in the centres where it is performed, and therefore, new learning areas are needed for residents working in these centres for surgical training. These areas are various courses, video training sets and video platforms watched over the internet. The most frequently used platforms are YouTube® and WebSurg®. Our aim is to compare these two online video platforms in terms of laparoscopic gastrectomy and to evaluate the contribution of video platforms to surgical training and whether they have sufficient technical quality. MATERIALS AND METHODS We made a search on YouTube® and WebSurg® using the keyword 'laparoscopic gastrectomy' on 13 November 2020. A total of 143 videos were analysed, 111 of them on YouTube® and 32 on WebSurg®. All these videos were examined by two surgical oncologists experienced in laparoscopic gastrectomy and using laparoscopy in their daily practice. RESULTS The average video duration was 53.54 min in the YouTube® group and 18.20 min in the WebSurg® group, and this difference was found to be statistically significant between the two groups. According to the LGSS based on surgical procedures, the average score of WebSurg® videos was 10.37 and of YouTube® videos was 5.55, and there was a statistically significant difference between the two groups. CONCLUSIONS Today, video platforms have started to play a major role in surgical training. Of these platforms examined, WebSurg® is superior to YouTube® in terms of education and quality, but these platforms still have some deficiencies and need regulation.
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Affiliation(s)
- Cemil Yüksel
- Department of Surgical Oncology, SBU Ankara A.Y. Oncology Training and Research Hospital, Ankara, Turkey
| | - Serdar Çulcu
- Department of Surgical Oncology, SBU Ankara A.Y. Oncology Training and Research Hospital, Ankara, Turkey
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Roux-en-Y Reconstruction Following Distal Gastrectomy Reduced Endoscopic Reflux Esophagitis in Older Adults: Propensity Score–Matching Analysis. Int Surg 2021. [DOI: 10.9738/intsurg-d-20-00045.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
This study aimed to examine the functional outcomes of Roux-en-Y (RY) and Billroth I (BI) reconstruction methods following distal gastrectomy in patients ages ≥75 years with gastric cancer.
Summary of background data
RY and BI reconstructions are commonly performed after distal gastrectomy. However, no study has compared the 2 procedures in older adults.
Methods
We identified older patients who underwent RY (n = 103) or BI (n = 71) reconstruction following distal gastrectomy from 2011 to 2018 in our database. Patients in the RY and BI groups were matched by propensity scores, and each group included 62 patients. We compared short-term surgical outcomes and clinical findings at 1 year postoperatively. Additionally, risk factors for endoscopic reflux esophagitis following distal gastrectomy were evaluated.
Results
Reflux esophagitis, bile reflux, and remnant gastritis were significantly less frequent in RY reconstruction than in BI reconstruction. Moreover, both BI reconstruction and preoperative hiatus hernias were independent risk factors for postoperative endoscopic reflux esophagitis. Although the incidence of postoperative surgical complications following RY and BI was similar, RY was found to cause delayed gastric emptying more frequently than BI.
Conclusion
RY reconstruction is a favorable procedure to prevent reflux esophagitis in older patients, particularly in those with hiatal hernia.
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Nishizaki D, Ganeko R, Hoshino N, Hida K, Obama K, Furukawa TA, Sakai Y, Watanabe N. Roux-en-Y versus Billroth-I reconstruction after distal gastrectomy for gastric cancer. Cochrane Database Syst Rev 2021; 9:CD012998. [PMID: 34523717 PMCID: PMC8441595 DOI: 10.1002/14651858.cd012998.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gastric cancer is the fifth most common cancer diagnosed worldwide. Due to improved early detection rates of gastric cancer and technological advances in treatments, a significant improvement in survival rates has been achieved in people with cancer undergoing gastrectomy. Subsequently, there has been increasing emphasis on postgastrectomy syndrome (e.g. fullness, delayed emptying, and cold sweat, amongst others) and quality of life postsurgery. However, it is uncertain which types of reconstruction result in better outcomes postsurgery. OBJECTIVES To assess the evidence on health-related quality of life and safety outcomes of Roux-en-Y and Billroth-I reconstructions after distal gastrectomy for people with gastric cancer. SEARCH METHODS We searched the Cochrane Library and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase on 4 May 2021. We checked the reference lists of the included studies and contacted manufacturers and professionals in the field. There were no language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) allocating participants to Roux-en-Y reconstruction or Billroth-I reconstruction after distal gastrectomy for gastric cancer. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies identified by the search for eligibility and extracted data. The primary outcomes were health-related quality of life after surgery and incidence of anastomotic leakage. The secondary outcomes included body weight loss, incidence of bile reflux, length of hospital stay, and overall morbidity. We used a random-effects model to conduct meta-analyses. We assessed risk of bias of the included studies in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and the certainty of the evidence using the GRADE approach. MAIN RESULTS We included eight RCTs (942 participants) in the review. One study included both cancer patients and benign disease patients such as stomach ulcers. Two studies compared Roux-en-Y, Billroth-I, and Billroth-II reconstructions, whilst the other studies compared Roux-en-Y and Billroth-I directly. For the primary outcomes, the evidence suggests that there may be little to no difference in health-related quality of life between Roux-en-Y and Billroth-I reconstruction (standardised mean difference 0.04, 95% confidence interval (CI) -0.11 to 0.18; I² = 0%; 6 studies; 695 participants; low-certainty evidence due to study limitations and imprecision). The evidence for the effect of Roux-en-Y versus Billroth-I reconstruction on the incidence of anastomotic leakage is very uncertain (risk ratio (RR) 0.63, 95% CI 0.16 to 2.53; I² = 0%; 5 studies; 711 participants; very low-certainty evidence). The incidence of anastomotic leakage was 0.6% and 1.4% in the Roux-en-Y and Billroth-I groups, respectively. For the secondary outcomes, the evidence suggests that Billroth-I reconstruction may result in little to no difference in loss of body weight compared to Roux-en-Y reconstruction (mean difference (MD) 0.41, 95% CI -0.77 to 1.59; I² = 0%; 4 studies; 541 participants; low-certainty evidence). Roux-en-Y reconstruction probably reduces the incidence of bile reflux compared to Billroth-I reconstruction (RR 0.40, 95% CI 0.25 to 0.63; I² = 22%; 4 studies; 399 participants; moderate-certainty evidence). Billroth-I reconstruction may shorten postoperative hospital stay, but the evidence for this outcome is very uncertain (MD 0.96, 95% CI 0.16 to 1.76; I² = 56%; 7 studies; 894 participants; very low-certainty evidence). Billroth-I reconstruction may reduce postoperative overall morbidity compared to Roux-en-Y reconstruction (RR 1.47, 95% CI 1.02 to 2.11; I² = 0%; 7 studies; 891 participants; low-certainty evidence). AUTHORS' CONCLUSIONS The evidence suggests that there is little to no difference between Roux-en-Y and Billroth-I reconstruction for the outcome health-related quality of life. The evidence for the effect of Roux-en-Y versus Billroth-I reconstruction on the incidence of anastomotic leakage is very uncertain as the incidence of this outcome was low. Although the certainty of evidence was low, we found some possibly clinically meaningful differences between Roux-en-Y and Billroth-I reconstruction for short-term outcomes. Roux-en-Y reconstruction probably reduces the incidence of bile reflux into the remnant stomach compared to Billroth-I reconstruction. Billroth-I reconstruction may shorten postoperative hospital stay compared to Roux-en-Y reconstruction, but the evidence is very uncertain. Billroth-I reconstruction may reduce postoperative overall morbidity compared to Roux-en-Y reconstruction. Future trials should include long-term follow-up of health-related quality of life and body weight loss.
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Affiliation(s)
| | - Riki Ganeko
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Norio Watanabe
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
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Comparison of Surgical Outcomes for Finsterer and the Roux-en-Y Reconstruction after Distal Gastrectomy for Gastric Carcinoma. Gastroenterol Res Pract 2021; 2021:5562776. [PMID: 34497642 PMCID: PMC8419505 DOI: 10.1155/2021/5562776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/27/2021] [Accepted: 08/07/2021] [Indexed: 11/17/2022] Open
Abstract
Objective There have been surgical procedures to reconstruct the gastrointestinal continuity after distal gastrectomy. This study is aimed at comparing the surgical outcomes of reconstructing gastrointestinal continuity by the method of Finsterer and Roux-en-Y after distal gastrectomy due to cancer. Materials and methods. 86 patients, who underwent distal gastrectomy due to cancer, were divided into 2 groups for reconstructing gastrointestinal continuity from March 2014 to August 2018 at Viet Duc Hospital: group 1 (44 patients) by the Finsterer method and group 2 (42 patients) by the Roux-en-Y method. Results The concentrations of bilirubin and amylase in gastric liquid after first flatus were 97.6 mmol/l and 20016 mmol/l for group 1 and 0.5 mmol/l and 152 mmol/l for group 2 (p = 0.01), respectively. The rate of reflux with clinical manifestations was 45.7% for group 1 and 9.4% for group 2 (p = 0.001). The average operation time was 155.7 ± 25.9 (90-200) minutes for group 1 and 170.3 ± 22.3 (120-215) minutes for group 2 (p = 0.007). The number of lymph nodes was 19.1 ± 4.8 (13-37) for group 1 and 20.3 ± 4.5 (12- 33) for group 2 (p = 0.243). There was 1 case of mesenteric bleeding in group 2 (2.4%). The dumping syndrome occurred in group 1 (20%) and group 2 (9.4%) (p = 0.31). Conclusion The Finsterer and Roux-en-Y methods proved to be equally effective in their feasibility and safety. However, the Roux-en-Y method was better than the Finsterer method at limiting bile reflux and gastritis.
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Wu F, Ni Z, Diao H, Huang C, Wang S, Ge B, Huang Q. Recanalization in Uncut Roux-en-Y Reconstruction: An Animal Experiment and a Clinical Study. Front Surg 2021; 8:644864. [PMID: 34422889 PMCID: PMC8377251 DOI: 10.3389/fsurg.2021.644864] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/13/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Because of the challenge of jejunal closure recanalization, uncut Roux-en-Y reconstruction remains controversial. This study aimed to investigate the incidence of recanalization after uncut Roux-en-Y reconstruction in pigs and a small number of patients. Methods: Twenty miniature pigs were subjected to distal gastrectomy and uncut Roux-en-Y reconstruction using various rows of linear staplers to block the intestine. The pigs were sacrificed, and the incidence of recanalization was investigated 1 month after the operation. From December 2018 to June 2019, 10 patients with gastric cancer who had undergone elective laparoscopy-assisted distal gastrectomy and uncut Roux-en-Y reconstruction were included in this study. The primary study outcome was recanalization of the afferent limb, demonstrated by gastrointestinal radiography 1, 3, and 6 months after surgery. Various numbers of staple lines across the afferent jejunal limb were applied for closure: 2 staple lines in 2 pigs, 4 staple lines in 6 pigs, 6 staple lines in 8 pigs, and 8 staple lines in 4 pigs. Results: Complete recanalization was detected in all 20 pigs 1 month postoperatively. Recanalization was detected in five cases (50%) by gastrointestinal radiography. Among them, 1 case of recanalization was found in the 1st month after the operation, 2 cases were found in the 3rd month, and another 2 cases were found in the 6th month. Bile reflux was detected by endoscopy in 2 patients with recanalization. Conclusions: The occurrence of afferent limb recanalization after uncut Roux-en-Y reconstruction is high, and using additional staplers alone cannot decrease the incidence of recanalization. Based on our study, uncut Roux-en-Y reconstruction is not recommended.
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Affiliation(s)
- Feng Wu
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.,Department of General Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Zhejiang, China
| | - Zhizhan Ni
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hongliang Diao
- Department of General Surgery, Karamay Central Hospital, Karamay, China
| | - Chenshen Huang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Song Wang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bujun Ge
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qi Huang
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
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Matsumoto K, Tanaka S, Toyonaga T, Ikezawa N, Nishio M, Uraoka M, Yoshihara T, Sakaguchi H, Abe H, Yoshizaki T, Takao M, Takao T, Morita Y, Yokozaki H, Kodama Y. Clinical Impact of Different Reconstruction Methods on Remnant Gastric Cancer at the Anastomotic Site after Distal Gastrectomy. Clin Endosc 2021; 55:86-94. [PMID: 34384165 PMCID: PMC8831400 DOI: 10.5946/ce.2021.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/18/2021] [Indexed: 11/14/2022] Open
Abstract
Background/Aims The anastomotic site after distal gastrectomy is the area most affected by duodenogastric reflux. Different reconstruction methods may affect the lesion characteristics and treatment outcomes of remnant gastric cancers at the anastomotic site. We retrospectively investigated the clinicopathologic and endoscopic submucosal dissection outcomes of remnant gastric cancers at the anastomotic site. Methods We recruited 34 consecutive patients who underwent endoscopic submucosal dissection for remnant gastric cancer at the anastomotic site after distal gastrectomy. Clinicopathology and treatment outcomes were compared between the Billroth II and non-Billroth II groups. Results The tumor size in the Billroth II group was significantly larger than that in the non-Billroth II group (22 vs. 19 mm; p=0.048). More severe gastritis was detected endoscopically in the Billroth II group (2 vs. 1.33; p=0.0075). Moreover, operation time was longer (238 vs. 121 min; p=0.004) and the frequency of bleeding episodes was higher (7.5 vs. 3.1; p=0.014) in the Billroth II group. Conclusions Compared to remnant gastric cancers in non-Billroth II patients, those in the Billroth II group had larger lesions with a background of severe remnant gastritis. Endoscopic submucosal dissection for remnant gastric cancers in Billroth II patients involved longer operative times and more frequent bleeding episodes than that in patients without Billroth II.
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Affiliation(s)
- Kei Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Shinwa Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takashi Toyonaga
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Nobuaki Ikezawa
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Mari Nishio
- Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanao Uraoka
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Tomoatsu Yoshihara
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Hiroya Sakaguchi
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hirofumi Abe
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Tetsuya Yoshizaki
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Madoka Takao
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Toshitatsu Takao
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hiroshi Yokozaki
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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Wu CH, Huang KH, Chen MH, Fang WL, Chao Y, Lo SS, Li AFY, Wu CW, Shyr YM. Comparison of the Long-term Outcome Between Billroth-I and Roux-en-Y Reconstruction Following Distal Gastrectomy for Gastric Cancer. J Gastrointest Surg 2021; 25:1955-1961. [PMID: 33205309 DOI: 10.1007/s11605-020-04867-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Various reconstruction methods have been performed following distal gastrectomy; however, each reconstruction method has its own advantages and disadvantages. This study aims to compare the long-term outcomes between Billroth-I (B-I) and Roux-en-Y (RY) reconstruction after distal gastrectomy for gastric cancer. METHODS A total of 459 patients who underwent distal gastrectomy (B-I: 166, RY: 293) were included. Postoperative endoscopic findings and biliary tract stone formation were compared between the two groups. RESULTS At 1 year and 2 years postoperatively, gastric residue was more common in the RY group, gastritis was similar between groups, and bile reflux was more common in the B-I group. At 5 years postoperatively, gastric residue was similar between the groups, while gastritis and bile reflux were more common in the B-I group. Gastroesophageal reflux was more common in the B-I group at 1 year postoperatively, but gastroesophageal reflux became not significantly different between the groups at 2 and 5 years postoperatively. Gallstone formation was more common in the RY group and in patients aged ≥ 65 years. CONCLUSION During long-term follow-up, RY reconstruction was associated with lower incidence of bile reflux and gastritis, and higher incidence of gallstone formation than B-I reconstruction. The incidence of gastric residue was more common in the RY reconstruction group in the early postoperative period and became not significantly different between the two groups over time. For aged patients with RY reconstruction, cholecystectomy is recommended concurrently as gastrectomy.
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Affiliation(s)
- Chia-Hung Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-Hung Huang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Huang Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Liang Fang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Yee Chao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Su-Shun Lo
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,National Yang-Ming University Hospital, Yilan, Taiwan
| | - Anna Fen-Yau Li
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chew-Wun Wu
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Section 2, Shipai Road, Beitou District, Taipei, 11217, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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35
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Jiang H, Li Y, Wang T. Comparison of Billroth I, Billroth II, and Roux-en-Y reconstructions following distal gastrectomy: A systematic review and network meta-analysis. Cir Esp 2021; 99:412-420. [PMID: 34130813 DOI: 10.1016/j.cireng.2020.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/20/2020] [Indexed: 02/07/2023]
Abstract
Major surgical treatment for distal gastric cancer include Billroth I (BI), Billroth II (BII), and Roux-en-Y (RY). Since the optimal reconstruction methods remains inconclusive, we aimed to compare these treatments in terms of intraoperative and postoperative course after distal gastrectomy with a systematic review and random-effects network meta-analysis. We searched PubMed, Web of Knowledge, Ovid's database for prospective, randomized, controlled trials comparing the outcomes of BI, BII, and RY reconstruction after distal gastrectomy until January 2020. From the included studies, operative time, intraoperative blood loss, postoperative hospital stay, endoscopic findings and complications were extracted as the short- and long-term outcomes of reconstructions. The network meta-analysis was performed with R 3.5.2 software as well as "gemtc" and "forestplot" packages. Twelve randomized controlled trials (RCTs) involving 1662 patients were included. RY reconstruction has a lower risk and degree of remnant gastritis than BI and BII reconstructions(OR 0.40, 95%Crl: 0.24-0.64; OR 0.36, 95% Crl: 0.16-0.83, respectively). BI reconstruction method took significantly less time to perform as compared to BII and RY reconstruction (WMD 20, 95% Crl: 0.18-41; WMD 30, 95% Crl: 14-25, respectively). No differences in intraoperative blood loss, time to resumed oral intake, postoperative hospital stay, reflux oesophagitis and complications among the three reconstructions. The RY reconstruction after distal gastrectomy was more effective in preventing remnant gastritis than Billroth I and Billroth II reconstruction, although RY reconstruction was considered as technical complexity.
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Affiliation(s)
- Haitao Jiang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
| | - Yujie Li
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China.
| | - Tianfei Wang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
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Nakada K, Kawashima Y, Kinami S, Fukushima R, Yabusaki H, Seshimo A, Hiki N, Koeda K, Kano M, Uenosono Y, Oshio A, Kodera Y. Comparison of effects of six main gastrectomy procedures on patients' quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45. World J Gastrointest Surg 2021; 13:461-475. [PMID: 34122736 PMCID: PMC8167845 DOI: 10.4240/wjgs.v13.i5.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The effects of various gastrectomy procedures on the patient's quality of life (QOL) are not well understood. Thus, this nationwide multi-institutional cross-sectional study using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45), a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome, was conducted. AIM To compare the effects of six main gastrectomy procedures on the postoperative QOL. METHODS Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures [total gastrectomy with Roux-en-Y reconstruction (TGRY; n = 393), proximal gastrectomy (PG; n = 193), distal gastrectomy with Roux-en-Y reconstruction (DGRY; n = 475), distal gastrectomy with Billroth-I reconstruction (DGBI; n = 909), pylorus-preserving gastrectomy (PPG; n = 313), and local resection of the stomach (LR; n = 85)] were analyzed. Among the 19 main outcome measures of PGSAS-45, the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means. RESULTS TGRY and PG significantly impaired the QOL of postoperative patients. Postoperative QOL was excellent in LR (cardia and pylorus were preserved with minimal resection). In procedures removing the distal stomach, diarrhea subscale (SS) and dumping SS were less frequent in PPG than in DGBI and DGRY. However, there was no difference in the postoperative QOL between DGBI and DGRY. The most noticeable adverse effects caused by gastrectomy were meal-related distress SS, dissatisfaction at the meal, and weight loss, with significant differences among the surgical procedures. CONCLUSION Postoperative QOL greatly differed among six gastrectomy procedures. The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures, overcome surgical shortcomings, and enhance postoperative care.
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Affiliation(s)
- Koji Nakada
- Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Yoshiyuki Kawashima
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama 362-0806, Japan
| | - Shinichi Kinami
- Department of Surgical Oncology, Kanazawa Medical University, Kahoku-gun 920-0293, Ishikawa, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo 173-8605, Japan
| | - Hiroshi Yabusaki
- Department of Surgery, Niigata Cancer Center Hospital, Niigata 951-8566, Japan
| | - Akiyoshi Seshimo
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa 252-0374, Japan
| | - Keisuke Koeda
- Department of Medical Safety Science, Iwate Medical University, Iwate 028-3695, Japan
| | - Mikihiro Kano
- Department of Surgery, Hiroshima City Asa Citizens Hospital, Hiroshima 731-0293, Japan
| | - Yoshikazu Uenosono
- Department of Digestive Surgery, Imamura General Hospital, Kagoshima 890-0064, Japan
| | - Atsushi Oshio
- Faculty of Letters, Arts and Sciences, Waseda University, Tokyo 162-8644, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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Barchi LC, Ramos MFKP, Dias AR, Forones NM, Carvalho MPD, Castro OAP, Kassab P, Costa-Júnior WLD, Weston AC, Zilberstein B, Ferraz ÁAB, ZeideCharruf A, Brandalise A, Silva AMD, Alves B, Marins CAM, Malheiros CA, Leite CV, Bresciani CJC, Szor D, Mucerino DR, Wohnrath DR, JirjossIlias E, Martins Filho ED, PinatelLopasso F, Coimbra FJF, Felippe FEC, Tomasisch FDS, Takeda FR, Ishak G, Laporte GA, Silva HJT, Cecconello I, Rodrigues JJG, Grande JCD, Lourenço LG, Motta LMD, Ferraz LR, Moreira LF, Lopes LR, Toneto MG, Mester M, Rodrigues MAG, Franciss MY, AdamiAndreollo N, Corletta OC, Yagi OK, Malafaia O, Assumpção PP, Savassi-Rocha PR, Colleoni Neto R, Oliveira RJD, AissarSallun RA, Weschenfelder R, Oliveira SCVD, Abreu TBD, Castria TBD, Ribeiro Junior U, Barra W, Freitas Júnior WRD. BRAZILIAN GASTRIC CANCER ASSOCIATION GUIDELINES (PART 2): UPDATE ON TREATMENT. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 34:e1563. [PMID: 34008707 PMCID: PMC8121052 DOI: 10.1590/0102-672020210001e1563] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND : The II Brazilian Consensus on Gastric Cancer of the Brazilian Gastric Cancer Association BGCA (Part 1) was recently published. On this occasion, countless specialists working in the treatment of this disease expressed their opinion in the face of the statements presented. AIM : To present the BGCA Guidelines (Part 2) regarding indications for surgical treatment, operative techniques, extension of resection and multimodal treatment. METHODS To formulate these guidelines, the authors carried out an extensive and current review regarding each declaration present in the II Consensus, using the Medline/PubMed, Cochrane Library and SciELO databases initially with the following descriptors: gastric cancer, gastrectomy, lymphadenectomy, multimodal treatment. In addition, each statement was classified according to the level of evidence and degree of recommendation. RESULTS : Of the 43 statements present in this study, 11 (25,6%) were classified with level of evidence A, 20 (46,5%) B and 12 (27,9%) C. Regarding the degree of recommendation, 18 (41,9%) statements obtained grade of recommendation 1, 14 (32,6%) 2a, 10 (23,3%) 2b e one (2,3%) 3. CONCLUSION : The guidelines complement of the guidelines presented here allows surgeons and oncologists who work to combat gastric cancer to offer the best possible treatment, according to the local conditions available.
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Affiliation(s)
- Leandro Cardoso Barchi
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Faculty of Medicine São Leopoldo Mandic, Campinas, SP, Brazil
| | | | - André Roncon Dias
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Paulo Kassab
- Department of Surgery, Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Wilson Luiz da Costa-Júnior
- Department of Abdominal Surgery, AC Camargo Cancer Center, São Paulo, SP, Brazil
- Department of Medicine, Baylor College of Medicine, Houston,Texas
| | | | - Bruno Zilberstein
- Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
- Faculty of Medicine São Leopoldo Mandic, Campinas, SP, Brazil
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Grosek J, Zavrtanik H, Tomažič A. Health-related quality of life after curative resection for gastric adenocarcinoma. World J Gastroenterol 2021; 27:1816-1827. [PMID: 33967559 PMCID: PMC8072188 DOI: 10.3748/wjg.v27.i16.1816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/05/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND With improved survival in gastric cancer patients, health-related quality of life has become an important clinical endpoint alongside primary oncological outcomes. AIM To investigate health-related quality of life after various surgical procedures for gastric cancer treatment. METHODS The validated Slovenian version of the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30) and its gastric cancer-specific module (QLQ STO-22) was sent for self-completion to patients that underwent curative resection for gastric adenocarcinoma between January 2014 and December 2018 at our centre. In total, 116 patients responded. Scores were compared between patients after subtotal distal vs total gastrectomy and patients after subtotal distal gastrectomy with Billroth II vs Roux-en-Y reconstruction. RESULTS Interestingly, the extent of resection did not influence daily functioning; however, more dysphagia and eating restrictions were reported in patients after total gastrectomy when compared to patients after subtotal distal gastrectomy. Moreover, patients with Billroth II reconstruction after subtotal distal resection experienced worse physical and role functioning and reported more pain, fatigue and reflux compared to Roux-en-Y reconstruction. CONCLUSION Based on our results, Roux-en-Y reconstruction after subtotal distal gastrectomy should be preferred over Billroth II reconstruction. The data obtained from this study will help surgeons when preoperatively informing their patients about expected functional outcomes after gastrectomy and enable them to ensure proper supportive care of their patients in the postoperative period.
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Affiliation(s)
- Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Hana Zavrtanik
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana 1000, Slovenia
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Zhang LY, Ma JJ, Zang L, Hong HJ, Lu AG, He ZR, Jiang TY, Zhao X, Fingerhut A, Zheng MH. Staged laparoscopic management of locally advanced gastric cancer with outlet obstruction. J Surg Oncol 2021; 123 Suppl 1:S8-S14. [PMID: 33818776 DOI: 10.1002/jso.26342] [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: 11/04/2020] [Revised: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prognosis of patients with locally advanced gastric cancer with outlet obstruction is poor. Gastrectomy with curative intent is often initially impossible or difficult. OBJECTIVE We report our experience of curative distal gastrectomy after laparoscopic gastrojejunostomy and fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy to examine the feasibility and safety of this modified strategy for locally advanced gastric cancer with outlet obstruction, initially deemed unresectable. METHODS Between October 2017 and June 2019, 15 patients diagnosed with locally advanced gastric cancer with outlet obstruction sequentially underwent gastrojejunostomy, received four cycles of FLOT chemotherapy, and underwent laparoscopic distal gastrectomy with curative intent (R0 resection + D2 lymphadenectomy). Clinical data were retrospectively collected and analyzed. RESULTS R0 resection was possible in 12/15 patients, laparoscopically in 11, and one conversion to laparotomy was necessary. There was no perioperative mortality in the 12 patients. Pathologic evaluation of the resected specimens revealed that complete tumor grade regression 1a (TRG1a), TRG1b, TRG2, and TRG3 occurred in 3, 2, 4, and 3 patients, respectively. CONCLUSION This case series showed that curative surgical resection was feasible as a staged approach for patients with locally advanced gastric cancer with outlet obstruction, after initial staged gastrojejunostomy and chemotherapy.
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Affiliation(s)
- Lu-Yang Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun-Jun Ma
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Zang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hi-Ju Hong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ai-Guo Lu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zi-Rui He
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tian-Yu Jiang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Surgery, Section for Surgical Research, Medical University of Graz, Graz, Austria.,Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Min-Hua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Sakaguchi M, Hosogi H, Tokoro Y, Yagi D, Shimoike N, Akagawa S, Kanaya S. Functional Outcomes of Delta-Shaped Anastomosis After Laparoscopic Distal Gastrectomy. J Gastrointest Surg 2021; 25:397-404. [PMID: 32026335 DOI: 10.1007/s11605-020-04516-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND We invented a simple and secure method of intracorporeal gastroduodenostomy, the delta-shaped anastomosis (DA), using endoscopic linear stapler only and standardized the DA procedure by resecting two-thirds of the stomach based on the anatomical landmarks. This study aimed to evaluate the feasibility of the standardized DA as the standard reconstruction procedure after a laparoscopic distal gastrectomy assessing functional outcomes including postoperative complications, body weight loss, nutritional status, and endoscopic findings. METHODS The medical records of 349 patients with gastric cancer who underwent laparoscopic distal gastrectomy from April 2011 to December 2017 at our hospital were retrospectively reviewed. Functional outcomes were assessed according to nutritional status and endoscopic findings. RESULTS The operation time was shorter and complication rate was lower in the standardized DA than those in Billroth-II (BII) and Roux-en-Y (RY). The body weight loss in DA was 10% 1 year postoperatively and remained stable during the follow-up period, which showed no significant difference. The endoscopic findings showed the ratio of residual food in DA was lower than that in RY (DA:RY = 13.3%:13.6% and 8.4%:33.3% at 1 and 3 years postoperatively, respectively). Severe gastritis was extremely rare in DA (6.7% at 1 year and 15.6% at 3 years postoperatively). Bile reflux was more often found in DA than RY (DA:RY = 19.9%:4.8% and 26.6%:0% at 1 and 3 years postoperatively, respectively). Reflux esophagitis was found 10% of DA only. CONCLUSIONS Functional outcomes of the standardized DA were satisfactory and feasible. Our intracorporeal Billroth-I reconstruction, by resecting two-thirds of the stomach, can be one of the standard reconstruction methods after a laparoscopic distal gastrectomy.
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Affiliation(s)
- Masazumi Sakaguchi
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.
| | - Hisahiro Hosogi
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
| | - Yukinari Tokoro
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
| | - Daisuke Yagi
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
| | - Norihiro Shimoike
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin Akagawa
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.,Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Seiichiro Kanaya
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
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Weber MC, Berlet M, Novotny A, Friess H, Reim D. [Reconstruction following gastrectomy]. Chirurg 2021; 92:506-514. [PMID: 33496813 DOI: 10.1007/s00104-020-01350-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 12/12/2022]
Abstract
Minimally invasive surgical techniques with respect to the treatment of gastric cancer have progressed rapidly over the last few years. Especially in Asia, where the incidence of gastric cancer is ten times higher than in Europe, surgery for gastric cancer is steadily evolving, especially regarding laparoscopic and robot-assisted procedures. This review first discusses the different options for reconstruction of the gastrointestinal passage after gastrectomy, ranging from Billroth procedures to the latest developments, such as the double tract reconstruction. In particular, the possibility of function-preserving partial gastrectomy, such as proximal and distal gastric resection and the corresponding reconstruction techniques are presented. The latest studies and technical developments are presented, especially with respect to laparoscopically assisted, completely laparoscopic and robot-assisted gastrectomies.
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Affiliation(s)
- Marie-Christin Weber
- Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Maximilian Berlet
- Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Alexander Novotny
- Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Helmut Friess
- Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - Daniel Reim
- Klinikum rechts der Isar, Klinik und Poliklinik für Chirurgie, TU München, Ismaninger Straße 22, 81675, München, Deutschland.
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Rupp SK, Stengel A. Influencing Factors and Effects of Treatment on Quality of Life in Patients With Gastric Cancer-A Systematic Review. Front Psychiatry 2021; 12:656929. [PMID: 34276435 PMCID: PMC8280526 DOI: 10.3389/fpsyt.2021.656929] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/31/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Gastric cancer (GC) is one of the leading causes of death worldwide. It is associated with several disease-related impairments contributing to the psycho-social burden of those patients, such as deterioration of well-being and overall quality of life (QOL). The aim of this study is to present the wide range of factors potentially impacting patients' overall well-being and possible preventive interventions. Methods: This systematic review was conducted in October 2020 with a search in the PubMed, MedLine, PsycInfo, and Google Scholar databases. We used the keywords "gastric cancer," "gastric neoplasm," and each of them combined with "quality of life," "depression," and "anxiety" to identify all relevant articles reporting about potential impact factors influencing the overall well-being of patients suffering from gastric cancer. Results: Finally, 125,490 articles were found, of which 125,431 were excluded in several steps of screening. Inclusion criteria were studies carried out on human ≥18 years of age, studies in English or German language, clinical trials, registry-based studies, cohort studies, population-based studies, and certain titles and abstracts. After screening for eligibility 35 potential factors influencing overall well-being in patients with GC were identified and classified into 9 important categories: genetic condition, treatment method, blood markers, nutritional status, daily living, state of health, mental state, supportive care, and alternative treatment. Conclusion: Since various factors are involved in the development of patients' overall well-being, timely treatment of psycho-social impairments by physicians and psychologists is of enormous importance. Preventing psycho-social burden by improving patients' QOL should be of high importance in the treatment regimen of patients with GC.
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Affiliation(s)
- Sophia Kristina Rupp
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Section Psychooncology, Comprehensive Cancer Center Tübingen Stuttgart, University Hospital Tübingen, Tübingen, Germany.,Department for Psychosomatic Medicine, Charité Center for Internal Medicine and Dermatology, Charite-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Gong J, Wang B, Wang J, Li Y, Cao Y, Li W, Shang M, Huang L. Continuous Jejunal Pouch and Residual Stomach Anastomosis Combined with Jejunal Lateral Anastomosis: An Improved Method of Gastrointestinal Reconstruction following Distal Gastrectomy. J INVEST SURG 2020; 35:293-300. [PMID: 33342314 DOI: 10.1080/08941939.2020.1854397] [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: 10/22/2022]
Abstract
AIM Currently, there is no optimal digestive tract reconstruction technique well recognized by scholars after distal gastrectomy. A new reconstruction method, which was modified from the classic Roux-en-Y procedure, the continuous jejunal pouch and residual stomach anastomosis combined with jejunal lateral anastomosis (Contin-L), was established. In order to fully clarify the superiority of this procedure, this study has conducted a systematic analysis and prepared a summary of the clinical data of patients who underwent distal gastrectomy for gastric cancer. METHODS From June 2013 to March 2016, we enrolled 198 patients with gastric cancer who underwent radical D2 distal gastrectomy. According to the reconstruction methods, these patients were divided into three groups: Contin-L (n = 74), Billroth II (n = 59), and Roux-en-Y (n = 65) groups. The operation time for reconstruction, complications, prognostic nutritional index (PNI), and the Visick grading were analyzed. RESULTS Regarding long-term complications, such as reflux gastritis, the Contin-L procedure showed significantly better results than Billroth II (p < 0.0001). Regarding the long-term postoperative nutritional status, such as the PNI and body weight recovery, the Contin-L procedure displayed significantly better results than Billroth II and Roux-en-Y (p < 0.05). Postoperative subjective feelings evaluated by Visick grading were significantly more improved in the Contin-L than in the Billroth II and Roux-en-Y groups (p ≤ 0.01). CONCLUSIONS The Contin-L procedure gave full play to the advantages of jejunal continuity, and pouch and lateral anastomoses, which significantly reduced short- and long-term complications, and improved the long-term patient quality of life following the surgical procedure.
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Affiliation(s)
- JiaQing Gong
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - Bin Wang
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - JunQing Wang
- Department of Radiology, The General Hospital of Western Theater Command, ChengDu, Sichuan Province, China
| | - YunMing Li
- Depaartment of Medical Management, The General Hospital of Western Theater Command, ChengDu, Sichuan Province, China
| | - YongKuan Cao
- Center of General Surgery, The General Hospital of Western Theater Command, ChengDu, Sichuan Province, China
| | - Wei Li
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - Min Shang
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - Ling Huang
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
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Zhu G, Hu J, Lu L, Wei S, Xiong Z. A Comparison of the Short-Term Clinical Effects Between Totally Laparoscopic Radical Gastrectomy With Modified Roux-en-Y Anastomosis and Laparoscopic-Assisted Radical Gastrectomy With Roux-en-Y Anastomosis. Technol Cancer Res Treat 2020; 19:1533033820973281. [PMID: 33172344 PMCID: PMC7672738 DOI: 10.1177/1533033820973281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare the short-term clinical effects between totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis; to explore the safety, feasibility and short-term effect of totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis. Methods: Data of 75 patients who underwent totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis, and 95 patients who underwent laparoscopic-assisted radical gastrectomy with Roux-en-Y anastomosis by the same surgical team were analyzed. During the modified Roux-en-Y anastomosis, the stomach separation and regional lymph node dissection were completed under a laparoscope; the specimen was placed in a bag; gastrojejunostomy was completed; the subumbilicus hole was enlarged to 3 cm; the specimen was taken out; then, the proximal and distal ends of the small intestine were moved outside of the abdominal wall to complete the small intestine-small intestine end-to-side anastomosis. Results: All 170 operations were successful. The differences in the time of anastomosis and the number of dissected lymph nodes between the 2 groups were not statistically significant (P > 0.05), but in the totally-MA group the amount of bleeding and the length of incision significantly decreased (P < 0.05). The recovery time as measured by breathing unassisted, drinking fluids and getting out of bed was significantly shorter than those in the laparoscopic-assisted group (P < 0.05), and the pain score 1 day after surgery was significantly lower than that of the laparoscopic-assisted group (P < 0.05). One case of duodenal stump leakage and 1 case of esophagojejunostomy leakage were found in the laparoscopic-assisted group. In the totally-MA group, there were no complications such as anastomotic leakage, anastomotic stenosis or anastomotic bleeding, but 2 patients with double primary carcinoma underwent joint radical resection. Conclusion: Compared with laparoscopic-assisted surgery, totally laparoscopic radical gastrectomy with modified Roux-en-Y anastomosis has the advantages of being safer and less traumatic, with associated reductions in bleeding and pain.
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Affiliation(s)
- Guangsheng Zhu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Junjie Hu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Li Lu
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Shaozhong Wei
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
| | - Zhiguo Xiong
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, University of Science and Technology Huazhong, Wuhan, China
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Hu Y, Vos EL, Baser RE, Schattner MA, Nishimura M, Coit DG, Strong VE. Longitudinal Analysis of Quality-of-Life Recovery After Gastrectomy for Cancer. Ann Surg Oncol 2020; 28:48-56. [PMID: 33125569 DOI: 10.1245/s10434-020-09274-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with quality-of-life recovery after gastrectomy. METHODS Patients anticipated to undergo gastric cancer resection were invited to complete the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and STO22 surveys in the preoperative setting and at 0-1.5 months (early), > 1.5-6 months (intermediate), and > 6-18 months (late) following resection. Quality-of-life recovery was measured as paired differences between pre- and postoperative results. Multivariable linear regression identified factors associated with preoperative quality of life and degree of change following resection. RESULTS Across 393 participants, response rates at the intermediate and late postoperative time points were 58% (n = 228) and 71% (n = 277), respectively. Relative to baseline, median global health scale decreased in the early (- 15.1 pts, p < 0.001) and intermediate (- 3.6 pts, p = 0.02) time points, but recovered by the late time point (+ 1.2 pts, p = 0.411). Relative to distal/subtotal gastrectomy, proximal/total gastrectomy was associated with worse recovery in both the early and late time points. Surgical complications were associated with worse early recovery. Patients who presented with locally advanced tumors (T3-T4) had lower preoperative quality-of-life scores, and more readily recovered to baseline after surgery. A minimally invasive approach was not associated with postoperative recovery. CONCLUSIONS Most patients recover to baseline within 1 year following major gastrectomy, and recovery is easier with more limited resections. Patients with locally advanced tumors tend to have poorer baseline quality of life, which may improve following resection.
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Affiliation(s)
- Yinin Hu
- Division of General and Oncologic Surgery, Department of Surgery, University of Maryland Baltimore, Baltimore, MD, USA
| | - Elvira L Vos
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Mark A Schattner
- Department of Gastroenterology, Hepatology, and Nutrition, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Makoto Nishimura
- Department of Gastroenterology, Hepatology, and Nutrition, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Division of Surgical Oncology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Jiang H, Li Y, Wang T. Comparison of Billroth I, Billroth II, and Roux-en-Y reconstructions following distal gastrectomy: A systematic review and network meta-analysis. Cir Esp 2020. [PMID: 33092808 DOI: 10.1016/j.ciresp.2020.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Major surgical treatment for distal gastric cancer include Billroth I (BI), Billroth II (BII), and Roux-en-Y (RY). Since the optimal reconstruction methods remains inconclusive, we aimed to compare these treatments in terms of intraoperative and postoperative course after distal gastrectomy with a systematic review and random-effects network meta-analysis. We searched PubMed, Web of Knowledge, Ovid's database for prospective, randomized, controlled trials comparing the outcomes of BI, BII, and RY reconstruction after distal gastrectomy until January 2020. From the included studies, operative time, intraoperative blood loss, postoperative hospital stay, endoscopic findings and complications were extracted as the short- and long-term outcomes of reconstructions. The network meta-analysis was performed with R 3.5.2 software as well as "gemtc" and "forestplot" packages. Twelve randomized controlled trials (RCTs) involving 1662 patients were included. RY reconstruction has a lower risk and degree of remnant gastritis than BI and BII reconstructions(OR 0.40, 95%Crl: 0.24-0.64; OR 0.36, 95% Crl: 0.16-0.83, respectively). BI reconstruction method took significantly less time to perform as compared to BII and RY reconstruction (WMD 20, 95% Crl: 0.18-41; WMD 30, 95% Crl: 14-25, respectively). No differences in intraoperative blood loss, time to resumed oral intake, postoperative hospital stay, reflux oesophagitis and complications among the three reconstructions. The RY reconstruction after distal gastrectomy was more effective in preventing remnant gastritis than Billroth I and Billroth II reconstruction, although RY reconstruction was considered as technical complexity.
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Affiliation(s)
- Haitao Jiang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
| | - Yujie Li
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China.
| | - Tianfei Wang
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China; Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, China; Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, China
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Zhou W, Dong CZ, Zang YF, Xue Y, Zhou XG, Wang Y, Ding YL. Initial experience of single-incision plus one port left-side approach totally laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction. World J Gastroenterol 2020; 26:4669-4679. [PMID: 32884224 PMCID: PMC7445872 DOI: 10.3748/wjg.v26.i31.4669] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/21/2020] [Accepted: 07/23/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Single incision plus one port left-side approach (SILS+1/L) totally laparoscopic distal gastrectomy (TLDG) is an emerging technique for the treatment of gastric cancer. Reduced port laparoscopic gastrectomy has a number of potential advantages for patients compared with conventional laparoscopic gastrectomy: relieving postoperative pain, shortening hospital stay and offering a better cosmetic outcome. Nevertheless, there are no previous reports on the use of SILS+1/L TLDG with uncut Roux-en-Y (uncut R-Y) reconstruction.
AIM To investigate the initial feasibility of SILS+1/L TLDG with uncut Roux-en-Y digestive tract reconstruction (uncut R-Y reconstruction) to treat distal gastric cancer.
METHODS A total of 21 patients who underwent SILS+1/L TLDG with uncut R-Y reconstruction for gastric cancer were enrolled. All patients were treated at The Second Hospital of Shandong University. Reconstructions were performed intracorporeally with 60 mm endoscopic linear stapler and 45 mm no-knife stapler. The clinicopathological characteristics, surgical details, postoperative short-term outcomes, postoperative follow-up upper gastrointestinal radiography findings and endoscopy results were analyzed retrospectively.
RESULTS All SILS+1/L operations were performed by SILS+1/L TLDG successfully. The patient population included 13 men and 8 women with a mean age of 48.2 years (ranged from 40 years to 70 years) and median body mass index of 22.8 kg/m2. There were no conversions to open laparotomy, and no other port was placed. The mean operation time was 146 min (ranged 130-180 min), and the estimated mean blood loss was 54 mL (ranged 20-110 mL). The mean duration to flatus and discharge was 2.3 (ranged 1-3.5) and 7.3 (ranged 6-9) d, respectively. The mean number of retrieved lymph nodes was 42 (ranged 30-47). Two patients experienced mild postoperative complications, including surgical site infection (wound at the navel incision) and mild postoperative pancreatic fistula (grade A). Follow-up upper gastrointestinal radiography and endoscopy were carried out at 3 mo postoperatively. No patients experienced moderate or severe food stasis, alkaline gastritis or bile reflux during the follow-up period. No recanalization of the biliopancreatic limb was found.
CONCLUSION SILS+1/L TLDG with uncut R-Y reconstruction could be safely performed as a reduced port surgery.
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Affiliation(s)
- Wei Zhou
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Chang-Zheng Dong
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yi-Feng Zang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Ying Xue
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Xing-Guo Zhou
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yu Wang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
| | - Yin-Lu Ding
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong Province, China
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Lee Y, Lee CM, Park S, Kim JH, Park SH. Comparison of the Clinical Outcomes Between Isoperistaltic and Antiperistaltic Anastomoses After Laparoscopic Distal Gastrectomy for Patients With Gastric Cancer. Front Oncol 2020; 10:1237. [PMID: 32850372 PMCID: PMC7411350 DOI: 10.3389/fonc.2020.01237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background: No consensus exists regarding the superiority of either of the two types of gastrointestinal anastomosis, which are isoperistaltic and antiperistaltic. This study aimed to compare the clinical outcomes between isoperistaltic and antiperistaltic anastomoses after total laparoscopic distal gastrectomy (TLDG) in patients with gastric cancer. Methods: We retrospectively reviewed the medical records of patients with gastric cancer who underwent TLDG with Billroth II anastomosis between January 2014 and December 2018. The patients were divided into two groups according to the peristaltic direction of gastrointestinal anastomosis after TLDG. One group underwent isoperistaltic anastomosis (Iso group), and the other underwent antiperistaltic anastomosis (Anti group). Clinical outcomes were compared between the groups. Results: Of the 148 patients who underwent TLDG with Billroth II anastomosis, 124 were included in the Iso group and 24 were included in the Anti group. The Anti and Iso groups showed no significant difference with regard to the incidence of internal hernia (0.0 vs. 6.5%, respectively; p = 0.355). The incidence of bile reflux was more frequent in the Iso group than in the Anti group (p = 0.010), but food stasis was more common in the Anti group than in the Iso group (p = 0.006). Conclusion: In gastric cancer patients who underwent TLDG in which postoperative adhesion was minimized, antiperistaltic anastomosis may have created a physiologic barrier in gastrointestinal continuity. However, a large-scale study is necessary to validate the relationship between the digestive stream and the peristaltic direction.
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Affiliation(s)
| | - Chang Min Lee
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
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Kim YN, Choi YY, An JY, Choi MG, Lee JH, Sohn TS, Bae JM, Noh SH, Kim S. Comparison of Postoperative Nutritional Status after Distal Gastrectomy for Gastric Cancer Using Three Reconstructive Methods: a Multicenter Study of over 1300 Patients. J Gastrointest Surg 2020; 24:1482-1488. [PMID: 31309380 DOI: 10.1007/s11605-019-04301-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 05/02/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Perioperative nutritional status has been reported to be associated with short- and long-term outcomes after surgery in gastric cancer patients. This study compared changes in nutritional status after distal gastrectomy using the Billroth I (BI), Billroth II (BII), and Roux-en-Y (RY) reconstruction techniques in gastric cancer patients. MATERIALS AND METHODS Data from 1305 gastric cancer patients who underwent distal gastrectomy at two tertiary hospitals from January 2011 to December 2016 were reviewed. The patients were divided into three groups according to reconstruction type: BI, BII, and RY. We evaluated changes in nutritional parameters including body mass index (BMI), biochemical data, the prognostic nutritional index (PNI), nutritional risk index (NRI), and geriatric nutritional risk index (GNRI) preoperatively, and 3, 6, and 12 months after surgery. RESULTS Total protein, albumin, PNI, and NRI were significantly lower in the BII group than in the BI and RY groups during follow-up (P < 0.001). In multivariate analysis, reconstruction types were independently related to decreases in BMI (> 10%), low serum protein, albumin, and cholesterol 12 months after surgery. Compared with BI, BII was associated with decreased BMI, low protein, and albumin and RY was associated with decreased BMI and low cholesterol. CONCLUSION During the first year after gastric cancer surgery, postoperative nutritional status differed according to the reconstruction type; BI resulted in the least weight and nutritional loss, RY yielded results comparable with BI in the nutritional indexes, and BII resulted in the greatest nutritional loss.
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Affiliation(s)
- You Na Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon Young Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Yeong An
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Min-Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jun Ho Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Sung Sohn
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jae Moon Bae
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sung Hoon Noh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
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50
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Hu Y, Zaydfudim VM. Quality of Life After Curative Resection for Gastric Cancer: Survey Metrics and Implications of Surgical Technique. J Surg Res 2020; 251:168-179. [PMID: 32151826 DOI: 10.1016/j.jss.2020.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/07/2020] [Accepted: 02/01/2020] [Indexed: 02/07/2023]
Abstract
Gastric cancer is one of the most common cancers worldwide, and radical gastrectomy is an integral component of curative therapy. With improvements in perioperative morbidity and mortality, attention has turned to short- and long-term post-gastrectomy quality of life (QoL). This article reviews the common psychometric surveys and preference-based measures used among patients following gastrectomy. It also provides an overview of studies that address associations between surgical decision-making and postoperative health-related QoL. Further attention is focused on reported associations between technical aspects of the operation, such as extent of gastric resection, minimally-invasive approach, pouch-based conduits, enteric reconstruction, and postoperative QoL. While there are several randomized studies that include QoL outcomes, much remains to be explored. The relationship between symptom profiles and preference-based measures of health state utility is an area in need of further research.
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Affiliation(s)
- Yinin Hu
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor M Zaydfudim
- Division of Surgical Oncology, University of Virginia, Charlottesville, Virginia; Department of Surgery, Surgical Outcomes Research Center, University of Virginia, Charlottesville, Virginia.
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