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Xia Y, Sheng N, Wang Z, Zhu Q. The comparison of post-proximal gastrectomy digestive tract reconstruction methods. BMC Surg 2025; 25:1. [PMID: 39754095 PMCID: PMC11697823 DOI: 10.1186/s12893-024-02748-x] [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: 08/08/2024] [Accepted: 12/27/2024] [Indexed: 01/07/2025] Open
Abstract
OBJECTIVE Proximal gastrectomy (PG) is commonly used to remove proximal gastric cancer leading to gastroesophageal reflux and requires digestive tract reconstruction. This study is to compare the performance of esophagogastrostomy (EG), jejunal interposition (JI), and double tract reconstruction (DTR) on post-PG reconstruction effectiveness. METHODS A retrospective study was conducted using the clinical data of 94 PG patients who underwent digestive tract reconstruction by EG (37 patients), JI (29 patients) or DTR (28 patients). The safety of the reconstruction procedure and the incidence of surgical complications were evaluated using the Reflux Symptom Index (RSI), Gastroesophageal Reflux Disease Questionnaire (GERD-Q) scale score, gastroscopy, barium meal examination of digestive tract, and 24-h pH monitoring. RESULTS The DTR group showed significantly lower GERD-Q scores (p < 0.05) and RSI scores (p < 0.05) compared to the EG and JI groups. This indicates that DTR is more effective in preventing reflux esophagitis. The pre- and post-surgical GERD-Q scores assessed by esophageal 24-h pH acidity measurements and Los Angeles Grading were reduced in all patient groups, with the DTR group showing better results than the other two (p < 0.05). The results of the EORTC QLQ-STO22 questionnaire indicated that the DTR group had a higher overall health status score than the other two groups (p < 0.001). CONCLUSION EG had a short surgical duration and less bleeding. JI reduced the prevalence of reflux esophagitis. DTR presented improved prevention of reflux esophagitis and enhanced quality of life.
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Affiliation(s)
- Yang Xia
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Nengquan Sheng
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Zhigang Wang
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China
| | - Qingchao Zhu
- Department of Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China.
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Peng R, Shi Y, Zhang H, Xie QY, Yue C, Huang LL, Chen L, Sun GL, Xu WG, Wei W, Gu RM, Ming XZ, Chen HQ, Li G. Tunnel anastomosis: a modified flap technique in esophagogastrostomy as a novel antireflux technique after proximal gastrectomy. J Gastrointest Surg 2025; 29:101871. [PMID: 39490562 DOI: 10.1016/j.gassur.2024.10.026] [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: 07/07/2024] [Revised: 10/02/2024] [Accepted: 10/23/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND The prevalence of proximal gastric cancer (PGC) has been increasing rapidly worldwide. Postoperative reflux esophagitis after conventional esophagogastrostomy (EG) is a major problem that haunts surgeons. This study designed a novel antireflux technique called tunnel anastomosis in EG after proximal gastrectomy (PG). This study aimed to present the detailed procedures of tunnel anastomosis and to assess its safety and feasibility by comparing the surgical outcomes, reflux, and nutritional status of patients undergoing tunnel anastomosis and those undergoing double-tract jejunal interposition reconstruction (DTJIR). METHODS A total of 1718 patients undergoing gastrectomy were enrolled in this study. However, only 150 patients undergoing PG were ultimately analyzed, of which 21 patients underwent tunnel anastomosis and 129 patients underwent DTJIR. Propensity score matching (PSM) was used to reduce biases. RESULTS After 1:1 PSM, there were 21 patients in both groups. No significant differences were observed between the 2 groups regarding surgical approach, blood loss, operative time, reconstruction time, postoperative hospital stay, morbidity, and mortality. The incidence of reflux esophagitis in both groups was 9.5% (2/21) according to the endoscopic examination at the 12-month postoperative follow-up. No patient in the tunnel group was classified as grade B or higher according to the Los Angeles classification. Patients in the tunnel and DTJIR groups exhibited comparable postoperative nutritional status when assessing the body weight, albumin levels and prognostic nutritional index value at 3 and 6 months after surgery. CONCLUSION Tunnel anastomosis is a safe technique that offers a robust antireflux effect and can be performed in some suitable patients with PGC.
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Affiliation(s)
- Rui Peng
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Yun Shi
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Hao Zhang
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China; Department of Thoracic Surgery, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qing-Yu Xie
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Chao Yue
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Ling-Li Huang
- Department of Pharmacy, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Liang Chen
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Guang-Li Sun
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Wei-Guo Xu
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Wei Wei
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Rong-Min Gu
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Xue-Zhi Ming
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Huan-Qiu Chen
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China
| | - Gang Li
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, China.
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Zhang Z, Zhao T, Wang Y, Xue F, Pu Y, Du Q, Wu Y. Comparison of proximal gastrectomy with tubular esophagogastric anastomosis and total gastrectomy with Roux-en-Y reconstruction in the treatment of adenocarcinoma of the esophagogastric junction of Siewert type II/III at stage II. BMC Surg 2024; 24:382. [PMID: 39614266 DOI: 10.1186/s12893-024-02685-9] [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: 08/23/2024] [Accepted: 11/26/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND Tubular anastomosis is commonly used in proximal gastrectomy; however, its use in stage II esophagogastric conjugate cancer is currently unclear. In this study, we investigated the short- and long-term clinical outcomes of Siewert II/III adenocarcinoma of the esophagogastric junction after modified proximal gastrectomy with tubular esophagogastric anastomosis compared with total gastrectomy with Roux-en-Y reconstruction. METHODS We collected the clinical data of patients who underwent proximal gastrectomy tubular esophagogastric anastomosis (PG-TEA) and total gastrectomy Roux-en-Y reconstruction (TG-RY) from October 2015 to October 2018. The clinical characteristics, postoperative quality of life, nutritional status, and long-term survival outcomes of the two groups were compared. RESULTS There were 43 patients in the PG-TEA group and 80 patients in the TG-RY group, and there was no significant difference between the baseline data of the groups. The operation time of the PG-TEA group was shorter, there was less intraoperative bleeding, and the feeding time was earlier, which was conducive to postoperative recovery. Reflux esophagitis was more evident in the PG-TEA group than in the TG-RY group, and there was no significant difference in the incidence of anastomotic ulcers or other complications. Three months after surgery, the nutritional status of the PG-TEA group was better than the TG-RY group. By the 6th postoperative month, there was no significant difference between the two groups. Regarding quality of life, the PG-TEA group was superior to the TG-RY group in terms of diarrhea and dumping syndrome. In addition, the PG-TEA group had higher satisfaction with daily life and higher-quality meals. There was no significant difference in overall survival between the two groups. CONCLUSIONS Proximal gastrectomy tubular gastroesophageal anastomosis is a surgical procedure for stage II Siewert type II and III AEG. It achieves similar clinical outcomes to those after total gastrectomy and can be further applied in the clinic.
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Affiliation(s)
- Zhixing Zhang
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, 710061, P. R. China
- Yan 'an University School of Medicine, Yan 'an, Shaanxi, 716000, P. R. China
| | - Tiantian Zhao
- Yan 'an University School of Medicine, Yan 'an, Shaanxi, 716000, P. R. China
| | - Yixing Wang
- Yan 'an University School of Medicine, Yan 'an, Shaanxi, 716000, P. R. China
| | - Fei Xue
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, 710061, P. R. China
| | - Yansong Pu
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, 710061, P. R. China
| | - Qingguo Du
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, 710061, P. R. China.
| | - Yunhua Wu
- The Second Department of General Surgery, Shaanxi Provincial People's Hospital, 256 West Youyi Road, Xi'an, 710061, P. R. China.
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Liu BY, Wu S, Xu Y. Clinical efficacy and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in gastrectomy. World J Gastrointest Surg 2024; 16:2012-2022. [PMID: 39087109 PMCID: PMC11287685 DOI: 10.4240/wjgs.v16.i7.2012] [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: 02/03/2024] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND With the continuous progress of surgical technology and improvements in medical standards, the treatment of gastric cancer surgery is also evolving. Proximal gastrectomy is a common treatment, but double-channel anastomosis and tubular gastroesophageal anastomosis have attracted much attention in terms of surgical options. Each of these two surgical methods has advantages and disadvantages, so it is particularly important to compare and analyze their clinical efficacy and safety. AIM To compare the surgical safety, clinical efficacy, and safety of double-channel anastomosis and tubular gastroesophageal anastomosis in proximal gastrectomy. METHODS The clinical and follow-up data of 99 patients with proximal gastric cancer who underwent proximal gastrectomy and were admitted to our hospital between January 2018 and September 2023 were included in this retrospective cohort study. According to the different anastomosis methods used, the patients were divided into a double-channel anastomosis group (50 patients) and a tubular gastroesophageal anastomosis group (49 patients). In the double-channel anastomosis, Roux-en-Y anastomosis of the esophagus and jejunum was performed after proximal gastric dissection, and then side-to-side anastomosis was performed between the residual stomach and jejunum to establish an antireflux barrier and reduce postoperative gastroesophageal reflux. In the tubular gastroesophageal anastomosis group, after the proximal end of the stomach was cut, tubular gastroplasty was performed on the distal stump of the stomach and a linear stapler was used to anastomose the posterior wall of the esophagus and the anterior wall of the stomach tube. The main outcome measure was quality of life 1 year after surgery in both groups, and the evaluation criteria were based on the postgastrectomy syndrome assessment scale. The greater the changes in body mass, food intake per meal, meal quality subscale score, and total measures of physical and mental health score, the better the condition; the greater the other indicators, the worse the condition. The secondary outcome measures were intraoperative and postoperative conditions, the incidence of postoperative long-term complications, and changes in nutritional status at 1, 3, 6, and 12 months after surgery. RESULTS In the double-channel anastomosis cohort, there were 35 males (70%) and 15 females (30%), 33 (66.0%) were under 65 years of age, and 37 (74.0%) had a body mass index ranging from 18 to 25 kg/m2. In the group undergoing tubular gastroesophageal anastomosis, there were eight females (16.3%), 21 (42.9%) individuals were under the age of 65 years, and 34 (69.4%) had a body mass index ranging from 18 to 25 kg/m2. The baseline data did not significantly differ between the two groups (P > 0.05 for all), with the exception of age (P = 0.021). The duration of hospitalization, number of lymph nodes dissected, intraoperative blood loss, and perioperative complication rate did not differ significantly between the two groups (P > 0.05 for all). Patients in the dual-channel anastomosis group scored better on quality of life measures than did those in the tubular gastroesophageal anastomosis group. Specifically, they had lower scores for esophageal reflux [2.8 (2.3, 4.0) vs 4.8 (3.8, 5.0), Z = 3.489, P < 0.001], eating discomfort [2.7 (1.7, 3.0) vs 3.3 (2.7, 4.0), Z = 3.393, P = 0.001], total symptoms [2.3 (1.7, 2.7) vs 2.5 (2.2, 2.9), Z = 2.243, P = 0.025], and other aspects of quality of life. The postoperative symptoms [2.0 (1.0, 3.0) vs 2.0 (2.0, 3.0), Z = 2.127, P = 0.033], meals [2.0 (1.0, 2.0) vs 2.0 (2.0, 3.0), Z = 3.976, P < 0.001], work [1.0 (1.0, 2.0) vs 2.0 (1.0, 2.0), Z = 2.279, P = 0.023], and daily life [1.7 (1.3, 2.0) vs 2.0 (2.0, 2.3), Z = 3.950, P < 0.001] were all better than those of the tubular gastroesophageal anastomosis group. The group that underwent tubular gastroesophageal anastomosis had a superior anal exhaust score [3.0 (2.0, 4.0) vs 3.5 (2.0, 5.0) (Z = 2.345, P = 0.019] compared to the dual-channel anastomosis group. Hemoglobin, serum albumin, total serum protein, and the rate at which body mass decreased one year following surgery did not differ significantly between the two groups (P > 0.05 for all). CONCLUSION The safety of double-channel anastomosis in proximal gastric cancer surgery is equivalent to that of tubular gastric surgery. Compared with tubular gastric surgery, double-channel anastomosis is a preferred surgical technique for proximal gastric cancer. It offers advantages such as less esophageal reflux and improved quality of life.
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Affiliation(s)
- Bei-Ying Liu
- Department of Operation Room, The Affiliated Hospital, Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Shuai Wu
- Department of Urology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao 266001, Shangdong Province, China
| | - Yu Xu
- Department of Gastrointestinal Surgery, Fujian Provincial Hospital, Fuzhou 350013, Fujian Province, China
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Chen J, Wang F, Gao S, Yang Y, Zhao Z, Shi J, Wang L, Ren J. Surgical outcomes of laparoscopic proximal gastrectomy for upper-third gastric cancer: esophagogastrostomy, gastric tube reconstruction, and double-tract reconstruction. BMC Surg 2023; 23:309. [PMID: 37828530 PMCID: PMC10571476 DOI: 10.1186/s12893-023-02219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND There is no consensus on the optimal reconstruction technique after proximal gastrectomy. The purpose of this study was to retrospectively compare the surgical outcomes among esophagogastrostomy (EG) anastomosis, gastric tube (GT) reconstruction and double-tract (DT) reconstruction in patients who underwent laparoscopic proximal gastrectomy (LPG) to clarify the superior reconstruction method. METHODS This study enrolled 164 patients who underwent LPG at the Northern Jiangsu People's Hospital in Jiangsu between January 2017 to January 2022 (EG: 51 patients; GT: 77 patients; DT: 36 patients). We compared the clinical and pathological characteristics, surgical features, postoperative complications, nutritional status, and quality of life (QOL) among the above three groups. RESULTS Mean operative time was longer with the DT group than the remaining two groups (p = 0.001). With regard to postoperative complications, considerable differences in the postoperative reflux symptoms (p = 0.042) and reflux esophagitis (p = 0.040) among the three groups were found. For the nutritional status, total protein, hemoglobin and albumin reduction rates in the GT group were significantly higher than the other two groups at 12 months postoperatively. In the PGSAS-45, three assessment items were better in the DT group significantly compared with the esophageal reflux subscale (p = 0.047, Cohen's d = 0.44), dissatisfaction at the meal (p = 0.009, Cohen's d = 0.58), and dissatisfaction for daily life subscale (p = 0.012, Cohen's d = 0.56). CONCLUSIONS DT after LPG is a valuable reconstruction technique with satisfactory surgical outcomes, especially regarding reduced reflux symptoms, improving the postoperative nutritional status and QOL.
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Grants
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2020159 The Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
- YZ2023086 Social development project of Yangzhou, Yangzhou, China
- YZ2023086 Social development project of Yangzhou, Yangzhou, China
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Affiliation(s)
- Jianhua Chen
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China
| | - Fei Wang
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China
| | - Shuyang Gao
- Department of Clinical Medical College, The Yangzhou School of Clinical Medicine, Dalian Medical University, Yangzhou, People's Republic of China
| | - Yapeng Yang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Ziming Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Jiahao Shi
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
| | - Liuhua Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, People's Republic of China
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China
| | - Jun Ren
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Medical School, Yangzhou University, 98 Nantong West Road, Yangzhou, 225001, People's Republic of China.
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, People's Republic of China.
- Department of General Surgery, General Surgery Institute of Yangzhou, Northern Jiangsu People's Hospital, Yangzhou, People's Republic of China.
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Shi JK, Wang B, Zhang XS, Lv P, Chen YL, Ren SY. Multifactor analysis of the technique in total laparoscopic gastric cancer. World J Gastrointest Surg 2023; 15:2003-2011. [PMID: 37901745 PMCID: PMC10600762 DOI: 10.4240/wjgs.v15.i9.2003] [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: 06/30/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy. However, using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration. In order to overcome these issues and improve patient prognosis, muscle flap reconstruction technique has emerged. Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue. By covering the anastomotic site with muscle tissue, it not only enhances the stability of the anastomosis site but also increases blood supply, promoting healing and recovery of the anastomosis. Therefore, the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied. AIM To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients' prognosis. METHODS The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022. All patients underwent esophagogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy. Perioperative indicators were determined, and patients were followed up for 1 year. Furthermore, patient outcomes were observed within 1 year, followed by patient classification based on different outcomes. Moreover, clinicopathological parameters were observed and relevant factors affecting patient prognosis were analyzed. RESULTS The operation time was 318 ± 43 min, the formation time of esophageal double muscle flap anastomosis was 110 ± 13 min, the number of lymph node dissections was 26 ± 6, the incision length was 3 ± 0.6 cm, intraoperative bleeding volume was 48 ± 15 mL, first anal exhaust time was 5.3 ± 1.8 d, first meal time was 6.0 ± 1.6 d, length of hospital stay was 11.8 ± 2.5, and treatment cost was 5.8 ± 0.7 thousand yuan. The patient experienced three postoperative complications: 2 cases of pulmonary infection and 1 case of respiratory discomfort. During 1-year follow-up, 50 patients survived and 10 died. Univariate analysis revealed that histological types, tumor size, tumor-node-metastasis staging, vascular invasion, and postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting the prognosis of surviving patients. Furthermore, Cox regression analysis revealed that postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting patient prognosis. The survival time of the survival group was significantly higher than that of the death group (P < 0.05). CONCLUSION Esophagogastric anastomotic using muscle flap reconstruction exhibits good effects on patients who undergo total abdominal gastrectomy for cancer. Postoperative adjuvant radiotherapy and chemotherapy are the main factors affecting patient prognosis.
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Affiliation(s)
- Jia-Kun Shi
- Department of Gastrointestinal Surgery, Dalian Friendship Hospital, Dalian 116000, Liaoning Province, China
| | - Bo Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Xin-Sheng Zhang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Pin Lv
- Department of Gastrointestinal Surgery, Dalian Friendship Hospital, Dalian 116000, Liaoning Province, China
| | - Yun-Long Chen
- Department of Gastrointestinal Surgery, Dalian Friendship Hospital, Dalian 116000, Liaoning Province, China
| | - Shuang-Yi Ren
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Kolozsi P, Varga Z, Toth D. Indications and technical aspects of proximal gastrectomy. Front Surg 2023; 10:1115139. [PMID: 36874448 PMCID: PMC9978003 DOI: 10.3389/fsurg.2023.1115139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
According to the World Health Organization, gastric cancer is the fifth most common type of tumor, and is the third most common cause of tumor-associated death. Although gastric cancer incidence rates have decreased in the past few decades, the prevalence of proximal gastric cancer has been steadily rising in developed countries. Techniques regarding the improvement of treatment options must thus be developed. This can be achieved through incorporating both a wider use of endoscopic surgery (endoscopic mucosal resection-EMR, endoscopic submucosal dissection-ESD) and a review of applied surgical interventions. Even though there is no single international consensus available, the Japanese Gastric Cancer Association (JGCA) recommends proximal gastrectomy with D1+ lymphadenectomy in early gastric tumors. Despite recommendations from Asian guidelines and the short term outcomes of the KLASS 05 trial, surgical treatments in Western countries still rely on total gastrectomy. This is mostly due to technical and oncological challenges regarding surgical interventions in a proximal gastrectomy. However, the residual stomach after a proximal gastrectomy has been shown to diminish the incidence of dumping syndrome and anemia, and even improve postoperative quality of life (QoL). Therefore, it is necessary to define the place of proximal gastrectomy in the treatment of gastric cancers.
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Affiliation(s)
- Peter Kolozsi
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Zsolt Varga
- Department of Surgery, University of Debrecen, Debrecen, Hungary
| | - Dezso Toth
- Department of Surgery, University of Debrecen, Debrecen, Hungary
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Chen Y, Yu Y, Lv M, Shi Q, Li X. E2F1-mediated up-regulation of TOP2A promotes viability, migration, and invasion, and inhibits apoptosis of gastric cancer cells. J Biosci 2022. [DOI: 10.1007/s12038-022-00322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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9
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Yang Q, Mo W, Che X, Chen H, Cui C. Clinical Efficacy of Laparoscopic-Assisted Proximal Gastrectomy with Postoperative Double-Channel Digestive Tract Reconstruction: A Case-Control Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1587398. [PMID: 37324505 PMCID: PMC10264137 DOI: 10.1155/2022/1587398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2024]
Abstract
Objective To investigate the clinical effect of laparoscopic-assisted proximal gastrectomy with postoperative double-channel digestive tract reconstruction. Methods A total of 40 patients with proximal gastric cancer who underwent gastrectomy in Zhujiang Hospital, Southern Medical University, were selected to collect relevant clinical data. They were divided into two groups according to their treatment methods: TG-RY group (total gastrectomy with Roux-en-Y reconstruction group) and PG-DT group (proximal gastrectomy with double tract reconstruction group). The general data, perioperative indicators, nutritional indicators, and postoperative complications of the two groups were analyzed and compared. Results There was no statistical significance in the comparison of general data between the two groups, but the proportion of III stage patients of TNM stage in the PG-DT group was larger than that in the TG-RY group. Meanwhile, the intraoperative blood loss, postoperative hospital stay, and first exhaust time in PG-DT group were lower than those in TG-RY group (P < 0.05). After surgery, the nutritional indexes of the PG-DT group decreased, and the decrease degree was less than that of the TG-RY group, while the infection indicators of the PG-DT group increased less than that of the TG-RY group. Statistical analysis of postoperative complications showed that the total incidence of PG-DT group was lower than that of TG-RY group. Conclusion Proximal gastric cancer resection and postoperative DTR anastomosis can effectively speed up the recovery of patients and reduce the incidence of postoperative complications, with good efficacy. This experiment provides evidence for the advantages of various postoperative anastomosis methods and also provides a reliable basis for clinicians' diagnosis and treatment, thus effectively improving patients' postoperative quality of life.
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Affiliation(s)
- Qian Yang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Weisheng Mo
- Department of Intensive Care Unit, The Seventh Affiliated Hospital, Sun Yat-sen University, China
| | - Xiao Che
- Department of Abdominal Hernia Surgery, Maoming People's Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hongzhen Chen
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Chunhui Cui
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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10
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Long VD, Hai NV, Thong DQ, Dat TQ, Quoc HLM, Minh TA, Anh NVT, Huong TNG, Nunobe S, Bac NH, Vuong NL. Clinical Outcomes of Laparoscopic Proximal Gastrectomy With Double-Flap Reconstruction for Tumors in the Upper Third of the Stomach. Surg Laparosc Endosc Percutan Tech 2022; 32:409-414. [PMID: 35583586 DOI: 10.1097/sle.0000000000001053] [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: 01/22/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Laparoscopic proximal gastrectomy (LPG) has been a standard surgery for early gastric cancer in the upper third of the stomach and large esophagogastric junction gastrointestinal stromal tumor. However, how to reconstruct the stomach after LPG is still debated. This study aimed to evaluate the results of LPG with double-flap reconstruction. METHODS A retrospective study was performed with 14 patients undergoing LPG with double-flap reconstruction for early gastric cancer or large tumors in the upper third of the stomach from 2018 to 2021. We evaluated postoperative complications, gastroesophageal reflux and the gastric remnant's function using endoscopy in accordance with the Los Angeles and Residue-Gastritis-Bile classifications, and patients' quality of life by the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. RESULTS Median age was 54 years and 10 patients were male. There were 7 patients with gastrointestinal stromal tumor, 4 with leiomyoma and 3 with early-stage adenocarcinoma. No patient had major complications or required conversion to open surgery. During a median follow-up period of 24.6 months, 1 patient had late anastomotic stricture, 2 had metastasis, and 1 died. Endoscopic evaluation at 6 and 12 months showed good function of the gastric remnant in most patients. Patients' quality of life improved over time: mean GSRS score was 26.9±12.6, 20.3±7.2, and 18.8±4.2 at 6, 12, and 24 months, respectively. CONCLUSIONS LPG with double-flap reconstruction is feasible and safe for early gastric cancer or large tumors in the upper third of the stomach. The long-term functional outcomes and patients' quality of life were acceptable.
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Affiliation(s)
- Vo Duy Long
- Departments of Gastrointestinal Surgery
- Department of General Surgery, Faculty of Medicine
| | | | | | | | | | - Tran Anh Minh
- Departments of Gastrointestinal Surgery
- Department of General Surgery, Faculty of Medicine
| | | | | | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Nguyen Hoang Bac
- Departments of Gastrointestinal Surgery
- Department of General Surgery, Faculty of Medicine
| | - 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
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11
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Liao J, Qin H, Huang Z, Cai J, Mo X. Effect of Esophagus-Remnant Stomach Anterior Wall Anastomosis on Postoperative Reflux and Nutritional Status in Patients with Early- and Intermediate-Stage Proximal Gastric Cancer. J Laparoendosc Adv Surg Tech A 2022; 32:244-250. [PMID: 33666512 DOI: 10.1089/lap.2021.0016] [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] [Indexed: 12/24/2022] Open
Abstract
Purpose: To compare and analyze the incidence of postoperative reflux esophagitis (RE) in patients with early- and intermediate-stage proximal gastric cancer after proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach versus total gastrectomy plus Roux-en-Y anastomosis and to analyze the advantages and disadvantages of these anastomosis approaches. Methods: Hospitalization data of 23 patients with early- and intermediate-stage proximal gastric cancer were retrospectively analyzed. They were divided into an observation group who underwent proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach and a control group who underwent total gastrectomy plus Roux-en-Y anastomosis. Quality observation indicators were compared between the two groups. Results: There was no statistically significant difference between the groups in the number of lymph nodes cleared or the recurrence rate at 12 months postoperatively. The incidence of postoperative RE was significantly lower in the observation group (25%) than in the control group (80%). The operation time, postoperative length of hospital stay, appetite change, body mass index, and hemoglobin level at 6 months postoperatively were significantly better in the observation group than in the control group (P < .05). Conclusion: Proximal gastrectomy plus esophagus-remnant stomach anterior wall anastomosis with proper spacing between the reserved anastomotic stoma and the stump of the remnant stomach can be used as a preferred surgical procedure for early- and mid-stage proximal gastric cancer.
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Affiliation(s)
- Jiankun Liao
- Guangxi Clinical Research Center for Colorectal Cancer, Division of Colorectal & Anal Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Haiquan Qin
- Guangxi Clinical Research Center for Colorectal Cancer, Division of Colorectal & Anal Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Zigao Huang
- Guangxi Clinical Research Center for Colorectal Cancer, Division of Colorectal & Anal Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Jinghua Cai
- Guangxi Clinical Research Center for Colorectal Cancer, Division of Colorectal & Anal Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
| | - Xianwei Mo
- Guangxi Clinical Research Center for Colorectal Cancer, Division of Colorectal & Anal Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China
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12
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Peng R, Yue C, Wei W, Zhou B, Wen X, Gu RM, Ming XZ, Li G, Chen HQ, Xu ZK. Proximal gastrectomy may be a reasonable choice for patients with selected proximal advanced gastric cancer: A propensity score-matched analysis. Asian J Surg 2021; 45:1823-1831. [PMID: 34642056 DOI: 10.1016/j.asjsur.2021.09.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/25/2021] [Accepted: 09/30/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Whether proximal gastrectomy (PG) can be applied to patients with proximal advanced gastric cancer (AGC) remains controversial. We aimed to explore the oncological safety of PG for proximal AGC in this study. METHODS 452 patients undergoing surgery for proximal AGC in the Affiliated Cancer Hospital of Nanjing Medical University were enrolled in this study. 329 patients with AGC were finally analyzed, of which 254 patients underwent total gastrectomy (TG) and 75 patients underwent PG. We used propensity score-matched (PSM) analysis to reduce biases. RESULTS After PSM, 67 patients with proximal AGC were included in the PG group and TG group, respectively. The estimated 5-year OS rates for TG and PG group after PSM were 64.3% and 74.9%, respectively, and no significant difference in OS existed between the two groups (p = 0.275). Multivariate analysis showed that PG was not an independent prognostic factor. Incidence of metastasis in No.5 or 6 lymph node (LN) station was significantly higher in the patients with pathological T4 and Borrmann III tumors (9.9% and 10.6%) than those with pathological T2/3 and Borrmann I/II tumors (2.2% and 3.3%). No metastasis was observed in No.5 or 6 LN station in patients with pathological T2/3 tumors or Borrmann I/II tumors when tumor size was ≤4 cm. CONCLUSIONS PG is a reasonable choice for patients with selected proximal AGC, especially for those with tumors of size ≤4 cm, Borrmann type I/II, and pathological T2/3. Future prospective randomized trials should be conducted first in patients with these specific proximal tumors.
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Affiliation(s)
- Rui Peng
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China; Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chao Yue
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China
| | - Wei Wei
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China
| | - Bin Zhou
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China
| | - Xu Wen
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China
| | - Rong-Min Gu
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China
| | - Xue-Zhi Ming
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China
| | - Gang Li
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China.
| | - Huan-Qiu Chen
- Department of General Surgery, The Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, Jiangsu, 210009, China
| | - Ze-Kuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, 211166, China.
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13
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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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