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Cao C, Tian X, Wang XZ, Wang Q. Comparative analysis of conventional laparoscopic surgery and single-incision laparoscopic surgery in gastric cancer treatment: Outcomes and prognosis. World J Gastrointest Surg 2024; 16:3786-3793. [PMID: 39734434 PMCID: PMC11650222 DOI: 10.4240/wjgs.v16.i12.3786] [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: 08/26/2024] [Revised: 09/20/2024] [Accepted: 10/22/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Gastric cancer surgery has advanced with minimally invasive techniques. This study compares outcomes between single-incision laparoscopic surgery plus one port (SILS + 1) and conventional laparoscopic surgery (CLS) in treating gastric cancer. AIM To explore the curative effect of SILS + 1 and CLS on gastric cancer and their influences on prognosis. METHODS A total of 93 patients with gastric cancer undergoing radical gastrectomy in the hospital were retrospectively analyzed between September 2019 and September 2022. According to different surgical methods, they were divided into SILS + 1 group (n = 56) and CLS group (n = 37). The perioperative indexes, pain degree [visual analogue scale (VAS)] and stress response [C-reactive protein (CRP), white blood cell count (WBC)] in the two groups were compared. The postoperative complications, recurrence rate and mortality at 1 year after surgery were recorded. RESULTS Intraoperative blood loss was significantly lower in the SILS + 1 group (76.53 ± 8.12 mL) compared to the CLS group (108.67 ± 12.34 mL, P < 0.001), and the total incision length was also significantly shorter in the SILS + 1 group (5.29 ± 1.01 cm vs 9.45 ± 2.34 cm, P < 0.001). SILS + 1 patients experienced faster recovery, with shorter times to first flatus (1.94 ± 0.43 days vs 3.23 ± 0.88 days, P < 0.001) and ambulation (2.76 ± 0.58 days vs 4.10 ± 0.97 days, P < 0.001). Postoperative pain, as measured by VAS scores, was significantly lower in the SILS + 1 group on postoperative days 1, 2, and 3 (P < 0.001). Additionally, stress markers (CRP and WBC) were significantly lower in the SILS + 1 group on the first postoperative day (CRP: 6.41 ± 1.63 mg/L vs 7.82 ± 1.88 mg/L, P < 0.001; WBC: 6.34 ± 1.50 × 109/L vs 7.09 ± 1.61 × 109/L, P = 0.024). The complication rate in the SILS + 1 group was also significantly lower than in the CLS group (8.93% vs 27.03%, P = 0.020). However, there was no significant difference in recurrence rates between the two groups after one year (3.57% vs 8.11%, P > 0.05). CONCLUSION SILS + 1 and CLS have the comparable lymph node clearance effect in patients with gastric cancer. However, SILS + 1 is more beneficial to reduce intraoperative blood loss, relieve pain, alleviate stress response, reduce the incidence of complications and promote rapid postoperative recovery.
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Affiliation(s)
- Ce Cao
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Zibo 255036, Shandong Province, China
| | - Xue Tian
- Department of Oncology, Zibo Central Hospital, Zibo 255036, Shandong Province, China
| | - Xue-Zhao Wang
- Department of Urology Surgery, Zibo Central Hospital, Zibo 255036, Shandong Province, China
| | - Qing Wang
- Department of Hepatobiliary Surgery, Zibo Central Hospital, Zibo 255036, Shandong Province, China
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Chen X, Lin T, Zhao M, Yang J, Huang H, Zhao L, Liu H, Chen T, Chen H, Hu Y, Li G, Yu J. Safety and Efficacy of OGT-Assisted Overlap Oesophagojejunostomy Versus the Traditional Overlap Method in Laparoscopic Total Gastrectomy for Gastric/Gastroesophageal Junction (G/GEJ) Tumours. Ann Surg Oncol 2023; 30:2729-2738. [PMID: 36658250 DOI: 10.1245/s10434-022-13031-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/13/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Overlap guiding tube (OGT)-assisted overlap oesophagojejunostomy (EJS), which was first designed and reported by our team, has shown feasibility. However, its safety and efficiency have not yet been compared with the conventional overlap approach. METHODS We retrospectively analysed the data of 155 gastric/gastroesophageal junction (G/GEJ) cancer patients who underwent laparoscopic total gastrectomy by conventional (conventional group, n = 83) or OGT-assisted (OGT group, n = 72) overlap methods at Nanfang Hospital. The anastomotic efficiency and surgical outcomes were compared between the two groups. RESULTS The success rate of inserting an anvil fork into the oesophageal lumen at the first attempt in the OGT group was much higher than in the conventional group (86.7% vs. 97.2%, P = 0.019). Consistently, the duration of EJS (P < 0.001) in the OGT group was significantly shorter than that in the conventional group. Operatively, there was one case in which oesophageal pseudocanals developed; another case was converted to thoracoscopic surgery in the conventional group, but there were no such cases in the OGT group. In terms of postoperative recovery, the OGT group was superior to the conventional group. The incidence of postoperative complications (28.9% vs. 20.8%, P = 0.247) and the classification of complication severity (P = 0.450) were milder in the OGT group, although the difference was not statistically significant. Notably, the conventional group had four cases (4.8%) of oesophagojejunal anastomotic leakage (EJAL) and one case (1.2%) of anastomotic stenosis. In the OGT group, two patients (2.8%) developed EJAL, but none developed anastomotic stenosis or anastomotic bleeding. Neither group had any cases of unplanned secondary surgery or perioperative deaths. CONCLUSIONS The OGT-assisted method reduced the surgical difficulty of overlap EJS with good safety. This study provides new perspectives for optimizing EJS.
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Affiliation(s)
- Xinhua Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tian Lin
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Mingli Zhao
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jia Yang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Huilin Huang
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liying Zhao
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hao Liu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tao Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hao Chen
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanfeng Hu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Guoxin Li
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
| | - Jiang Yu
- Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumors, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Yin JH, Chen YH, Ren YB, Wang R, Su S, Jiang EL, Li YB, Wang T, Xiao WD, Du GS. Feasibility and preliminary experience of single-incision plus one-port laparoscopic total gastrectomy with Overlap esophagojejunostomy for gastric cancer: A study of 10 cases. Front Surg 2023; 9:1071363. [PMID: 36700036 PMCID: PMC9869672 DOI: 10.3389/fsurg.2022.1071363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Background This study aimed to explore the feasibility and safety of single-incision plus one-port laparoscopic total gastrectomy (SITG + 1) with Overlap esophagojejunostomy (SITG + 1-Overlap) and to share preliminary experiences. Methods This retrospective study included 10 patients with gastric cancer located in the cardia or body who underwent SITG + 1-Overlap between August 2020 and October 2021.The demographics, tumor characteristics, postoperative outcomes, and short-term complications of all the enrolled patients were summarized and statistically analyzed. Data were expressed as mean ± standard deviation (SD) if they were normally distributed. Otherwise, Median (Quartile1, Quartile3) was used. Results In the collective perioperative data of these 10 patients who underwent radical gastrectomy, the median of the length of transumbilical incision and blood loss were 3.0 cm and 100.0 ml respectively, and the mean operation time and 385.5 ± 51.6 min. Postoperative data indicated that the gastric tube was removed on 2.0 (2.0, 3.0) days, and the timing of first feeding, activity, flatus, and defecation was 1.5 (1.0, 2.0) days, 2.0 (2.0, 2.0) days, 3.0 (2.0, 3.0) days, and 3.8 ± 0.6 days, respectively. The timing of drainage tube removal was 4.6 ± 1.0 days after operation. The duration of hospital stay was 7.5 ± 1.2 days and the VAS pain scores for the 3 days following surgery were 3.0 (2.0, 3.3), 2.0 (2.0, 3.0), and 1.5 (1.0, 2.0) respectively. The mean number of retrieved lymph nodes was 30.7 ± 13.2. Most biochemical indicators gradually normalized with the recovery of the patients after surgery. No 30-day postoperative complications were noted. Conclusions For the first time, our preliminary data indicate the feasibility and safety of Overlap esophagojejunostomy in SITG + 1 surgery. This modified Overlap procedure has the potential to simplify the reconstruction procedure and lower the technical challenge of SITG + 1 radical gastrectomy for cardia or upper gastric cancer in the early and advanced stages.
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Affiliation(s)
- Jiu-Heng Yin
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yi-Hui Chen
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan-Bei Ren
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Rong Wang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Shuai Su
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - En-Lai Jiang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yun-Bo Li
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ting Wang
- Nursing Department, Nursing School of Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Wei-Dong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China,Correspondence: Wei-Dong Xiao Guang-Sheng Du
| | - Guang-Sheng Du
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China,Correspondence: Wei-Dong Xiao Guang-Sheng Du
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Du GS, Jiang EL, Qiu Y, Wang WS, Yin JH, Wang S, Li YB, Chen YH, Yang H, Xiao WD. Single-incision plus one-port laparoscopic gastrectomy versus conventional multi-port laparoscopy-assisted gastrectomy for gastric cancer: a retrospective study. Surg Endosc 2021; 36:3298-3307. [PMID: 34313862 DOI: 10.1007/s00464-021-08643-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We compared short-term perioperative outcomes after single-incision plus one-port laparoscopic gastrectomy (SILG+1) and conventional multi-port laparoscopy-assisted gastrectomy (C-LAG) for gastric cancer. METHODS The work was conducted between August 2017 and October 2019. A total of 90 patients with early or advanced gastric cancer were retrospectively analyzed: 43 patients of which underwent SILG+1, and 47 of which underwent C-LAG, respectively. These were divided into two groups: the total gastrectomy group (SILT+1 and C-LATG) and the distal gastrectomy group (SILD + 1 and C-LADG). The demographics, tumor characteristics, postoperative outcomes, and short-term complications of all enrolled patients were summarized and statistically analyzed. RESULTS The mean incision length in SILT+1 group was 5.40 cm shorter than that in C-LATG group (3.15 ± 0.43 vs. 8.55 ± 2.72, P < 0.001). This comparison between the SILD + 1 and the C-LADG group produced comparable results. The SILT+1 group underwent a 56.32 min longer operation than the C-LATG group (273.03 ± 66.80 vs. 216.71 ± 82.61, P = 0.0205). SILG+1 group had better postoperative visual analog scale (VAS) and cosmetic score than those of the C-LATG group (P < 0.05). There were no significant differences in preoperative demographics or 30-day postoperative complication rates between the SILG+1 and C-LAG groups. Tumor-related index, including mass size, histological type, number of retrieved lymph nodes, pathological tumor-node-metastasis (TNM) stage, and proximal and distal edges were all equivalent between the SILG+1 and the C-LAG group. CONCLUSIONS This retrospective study demonstrates the safety and feasibility of SILG+1 with D1+ or D2 lymphadenectomy for the treatment of early and advanced gastric cancers, compared with C-LAG.
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Affiliation(s)
- Guang-Sheng Du
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - En-Lai Jiang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yuan Qiu
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Wen-Sheng Wang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Jiu-Heng Yin
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Shuai Wang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yun-Bo Li
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Yi-Hui Chen
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Hua Yang
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China
| | - Wei-Dong Xiao
- Department of General Surgery, Xinqiao Hospital, Army Medical University, Xinqiaozhengjie 183, Shapingba District, Chongqing, 400037, People's Republic of China.
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