Application of Overlap anastomosis to Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer / 中华胃肠外科杂志

Objective@#To investigate the application value of Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy in gastric cancer.@*Methods@#Clinical data of 68 stage T1-2 gastric cancer patients undergoing laparoscopic distal gastrectomy for D2 radical gastrectomy from January 2015 to January 2016 at China Japan Union Hospital of Jilin University were retrospectively analyzed. Inclusion criteria: (1) no distant metastasis of gastric cancer confirmed by gastroscopy and pathology before surgery; (2) T1-2 tumor with diameter <3 cm; (3) the lesion locating in the antrum of the stomach with distance >1 cm from the pylorus, and no invasion into middle area; (4) R0 resection confirmed by postoperative pathology; (5) no history of abdominal surgery. Among 68 cases,23 cases were in Overlap anastomosis group and 45 cases in Billroth I anastomosis group. D2 lymph node dissection and distal gastrectomy were performed in both groups. In the Overlap anastomosis group, the duodenum and stomach were severed by a linear stapler under endoscopy, and the residual gastric curve anastomotic opening was selected. According to the tension between the duodenum and the remnant stomach, the anastomotic opening was selected at the upper edge of the remnant duodenum, and the anastomosis between the posterior wall of the remnant stomach and the upper wall of the duodenum was completed by placing the stapler under endoscopy. Then the common opening was closed and the remnant duodenum was resected. In the traditional Billroth I anastomosis group, pneumoperitoneum was discontinued after amputation of the duodenum under laparoscopy. The median incision of the upper abdomen was 9-12 cm. The distal stomach was pulled out to complete the excision of specimens, the extraction of specimens and Billroth I digestive tract reconstruction. The intraoperative and postoperative conditions of the two groups were compared with student t test (continuous variable) and chi-square test (categorica variable).@*Results@#Of the 68 patients,39 were males and 29 were females,with age of (65.5±10.2)(51 to 77)years. Differences in baseline data between Overlap group and Billroth I group were not statistically significant (all P>0.05). Laparoscopic surgery was successfully performed in both groups without conversion to open operation. As compared with the Billroth I group, the Overlap group had significantly shorter operation time [(149.8±10.1) minutes vs. (169.8±15.3) minutes, t=5.658,P=0.008], shorter anastomotic time of digestive tract reconstruction [(31.2±3.8) minutes vs. (36.3±3.3) minutes, t=3.389, P=0.003] and shorter abdominal incision length [(4.5±0.9) cm vs.(11.0±2.3) cm, t=13.244,P=0.004]. There were no significant differences between two groups in intraoperative blood loss [(92.9±22.4) ml vs. (87.0±7.3) ml,t=1.186,P=0.366], number of lymph node dissected (28.4±5.7 vs. 27.3±5.2, t=0.838, P=0.383), postoperative flatus time [(4.4±2.1) days vs.(4.2±1.8) days, t=0.391, P=0.563], morbidity of postoperative complication [4.3%(1/23) vs. 6.7%(3/45), χ2=0.148,P=0.701]. All the patients were followed up for 28±10 (10-46) months. There were no long-term complications, recurrence or death in two groups.@*Conclusion@#Overlap anastomosis in Billroth I digestive tract reconstruction after laparoscopic distal gastrectomy is safe and effective, and can reduce the anastomosis time.

Application value of programmed D2 radical gastrectomy for advanced gastric cancer / 中华消化外科杂志

Gastric cancer is one of the high incidence of malignant tumors in China,the incidence of which is in the second among the world and is only inferior to Japan.But the mortality of gastric cancer in China is 2 times of world's average level,which is often associated with low early diagnostic rate,big regional differentials in the surgical quantity of gastric cancer (especially D2 radical gastrectomy) and prognosis of patients influenced by surgical quantity.Therefore,a standardized treatment of gastric cancer is the current development trend and hotspot.The correct and programmed staging,evaluation,operation methods,approaches,lymph node dissection and digestive tract reconstruction are selected,thus improving the long-term survival of patients with advanced gastric cancer and reducing mortality in China.

Comparative study of 3D and 2D laparoscopic surgery for gastrointestinal tumors / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the technical advantages of 3D laparoscopic and 2D laparoscopic surgery for gastrointestinal tumors.</p><p><b>METHODS</b>Clinical data of gastrointestinal cancer patients undergoing 3D laparoscopic or 2D laparoscopic surgery from January 2015 to January 2017 in our department were retrospectively analyzed These patients included 93 gastric cancer cases undergoing laparoscopic radical resection (total gastrectomy, 48 cases in 3D group, 45 cases in 2D group), 45 rectal cancer cases undergoing radical resection combined with lateral lymph node dissection (27 cases in 3D group, 18 cases in 2D group) and 76 right colon cancer cases undergoing radical resection (37 cases in 3D group, 39 cases in 2D group). The enrolled criteria of cases were 18-80 years old and diagnosed as advanced gastric or colorectal cancer by pathological examination. Patients with preoperative distant metastasis, severe heart or lung diseases who were not suitable for laparoscopic surgery, combined organ resection and conversion to open surgery were excluded. The choice of surgical procedure was determined by the discussion between patients and surgeon. Operations were performed by the same surgical team. Total operation time, complex operation time (deep lymph node dissection time, endoscopic intestinal anastomosis time), number of harvested lymph node, number of times in wrong grasp (accurate grasp for the same site needs to position for two times or more) and intraoperative bleeding were compared between 3D group and 2D group.</p><p><b>RESULTS</b>There were no significant differences in baseline data between 3D group and 2D group. All the patients completed laparoscopic radical operation successfully without conversion to open surgery. In patients with gastric cancer, compared with 2D group, the total operation time was shorter [(185±25) min vs. (190±27) min, P<0.05]; dissection time of No.10 and 11d lymph node [(40±8) min vs. (55±12)min, P<0.05], and No.7, 8, 9 and 12 lymph node [(30±6) min vs. (41±9) min, P<0.05] was shorter; the number of times in wrong grasp (5±2 vs. 11±2, P<0.05) was less in 3D group. In patients with rectal cancer, compared with group 2D, 3D group had shorter time of lateral lymph node dissection [(27±6) min vs. (35±9) min, P<0.05] and laparoscopic anastomosis [(45±7) min vs. (58±11) min, P<0.05]; less number of times in wrong grasp (4±2 vs. 13±2, P<0.05]. In patients with right colon cancer, 3D group had shorter laparoscopic anastomosis time [(38±7) min vs. (44±5) min, P<0.05] and less number of times in wrong grasp (5±1 vs. 13±3, P<0.05] as compared to 2D group.</p><p><b>CONCLUSION</b>3D laparoscopic surgery for gastrointestinal tumors, compared with 2D laparoscopic technology has significant advantages, which can improve the spatial location and depth of operation, decrease the difficulty of fine operation, and shorten the operation time.</p>

Clinical efficacy of laparoscopy-assisted radical gastrectomy for gastric cancer in elderly patients / 中华老年医学杂志

Objective To investigate the safety and feasibility of laparoscopy-assisted radical gastrectomy in elderly gastric cancer patients aged over 70 years.Methods Clinical data of 222 elderly gastric cancer patients aged over 70 years receiving surgery from January 2010 to January 2015 were retrospectively analyzed.Patients were divided into the laparoscopy-assisted radical gastrectomy group (LAG group,n=106) and the conventional open gastrectomy group (OG group,n=116),depending on the surgery type.General information,surgical parameters,intra-operative blood pressure fluctuations & blood gas analysis,postoperative recovery and complication rates were compared between the two groups.Results There were no significant differences between the two groups in gender,age,preoperative coexisting diseases,tumor size and location,TNM staging or extent of resection (all P＞0.05).Compared with the OG group,blood loss (86.9±38.9) ml vs.(168.8±49.1) ml,t=10.923,P＜0.01),operative incision length [(9.20±1.55) cm vs.(16.50± 2.12) cm,t=8.788,P＜0.01],time to bowel function recovery [(3.20±1.09) d vs.(5.50±1.16) d,t=4.590,P＜0.01],hospital stay [(11.82±3.92) d vs.(16.14±4.69) d,t=2.234,P＜0.05] and postoperative complications (12.3％ vs.26.4％,x2 =5.186,P＜0.05) were reduced in the LAG group.The LAG group had higher levels of partial pressure of carbon dioxide in arterial blood (PaCO2) and lower levels of base excess than the OG group [(48.10±5.53) mmHg vs.(40.25± 4.66) mmHg,(-7.45±3.72) mmol/L vs.(-3.35±1.98) mmol/L,t=6.908 and 3.619,P＜ 0.01 and 0.05].However,there were no significant differences between the two groups in partial pressure of oxygen (PaO2),arterial oxygen saturation (SaO2) or hydrogen ion concentration (all P＞ 0.05).No significant differences in operation time or number of retrieved lymph nodes were found between the two groups [(196.1 ± 23.4) min vs.(184.2 ± 26.9) min,(28.7 ± 6.5) vs.(27.3 ± 5.6),t=1.174 and 0.515,both P＞0.05].Conclusions Laparoscopy-assisted radical gastrectomy is safe and practical in elderly patients aged over 70 years with gastric cancer and can achieve comparable effects of open radical gastrectomy with less invasiveness and faster recovery.

Effect analysis of three-dimensional and two-dimensional imaging systems in laparoscopic radical resection of rectal cancer / 中华消化外科杂志

Objective To compare the clinical effect of three-dimensional(3D)and two-dimensional(2D)imaging systems in laparoscopic radical resection of rectal cancer.Methods The retrospective cohort study was adopted.The clinical data of the 97 patients who underwent laparoscopic radical resection of rectal cancer at the Xinmin Branch of the China-Japan Union Hospital of Jilin University between May 2012 and December 2014 were collected.Of 97 patients,47 undergoing 3D laparoscopic radical resection of rectal cancer were allocated into the 3D group and 50 undergoing 2D laparoscopic radical resection of rectal cancer were allocated into the 2D group.The operation followed strictly tumor-free and total mesorectal excision principles.Observation indicators included:(1)surgical situations:operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected,postoperative complications and duration of hospital stay.(2)Follow-up situations:follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015.Measurement data with normal distribution were presented as-x±s and comparison between groups was analyzed using the t test.Count data were analyzed using the chi-square test.Results(1)Surgical situations:all the patients underwent successful laparoscopic radical resection of rectal cancer,without conversion to open surgery.Operation time,time of deep lymph nodes dissected,volume of intraoperative blood loss,bleeding volume of obturator lymph nodes dissected,number of lymph nodes dissected and duration of postoperative hospital stay were(134.6±18.5)minutes,(21.2±2.7)minutes,(65±20)mL,(16±3)mL,23.6±3.5,(8.2±2.3)days in the 3D group and(157.4±17.8)minutes,(25.2±2.5)minutes,(89±27)mL,(23±5)mL,20.5±2.8,(9.4±2.1)days in the 2D group,respectively,with statistically significant differencesbetween the 2 groups(t=2.999,3.739,2.327,4.221,2.337,1.274,P＜0.05).The postoperative complications were detected in 7 patients in the 3D group and 9 patients in the 2D group,with no statisfically significant difference between the 2 groups(x2=0.170,P＞0.05).(2)Follow-up situations:75 of 97 patients were followed up for 12-36 months with a median time of 24 months,including 35 in the 3D group and 40 in the 2D group,and they were tumor-free survival.Conclusion Compared with 2D laparoscopic radical resection of rectal cancer,3D laparoscopic radical resection of rectal cancer can shorten the operation time and reduce tissue damage and intraoperative blood loss,and it is beneficial to deep lymph node dissection.

Comparative study of three-dimensional and two-dimensional laparoscopic-assisted D2 radical gastrectomy in short-term efficacy / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the advantage and short-term efficacy of three-dimensional (3D) laparoscopic-assisted D2 radical gastrectomy for gastric cancer.</p><p><b>METHODS</b>Clinical data of 116 gastric cancer patients who underwent laparoscopic-assisted D2 radical gastrectomy in our department from January 2014 to August 2015 were analyzed retrospectively. Among 116 patients, 56 received 3D and 60 received two-dimensional(2D) technique respectively. All the surgeries were performed by the same team. The operative parameters, short-term efficacy and hospital expense were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences between the two groups in baseline data(all P>0.05). All the operations were performed successfully without conversion. Compared with 2D group, 3D group had shorter operative time [(186.2±22.8) minutes vs. (198.1±26.4) minutes, t=2.589, P=0.011], less intraoperative blood loss [(73.6±28.5) ml vs. (88.1±32.3)ml, t=2.555, P=0.012]. Whereas no significant differences in dissected lymph nodes(36.5±6.6 vs. 34.5±5.4, P=0.073), time to first flatus[(3.1±1.5) days vs. (3.3±1.8) days, P=0.729], length of hospital stay[(11.7±2.9) days vs. (12.6±3.1) days, P=0.088], incidence of postoperative complications [8.9%(5/56) vs. 11.7%(7/60), P=0.628] and hospitalization cost [(8.6±1.4)×10(4) yuan vs. (8.1±1.2)×10(4) yuan, P=0.055] were found between two groups.</p><p><b>CONCLUSION</b>Three-dimensional laparoscopic-assisted D2 radical gastrectomy may be advantageous over two-dimensional laparoscopic-assisted D2 radical gastrectomy.</p>

Application of en-bloc mesogastric excision in the treatment of advanced gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To evaluate the value of en-bloc mesogastric excision (EME) in the treatment of advanced gastric cancer.</p><p><b>METHODS</b>A retrospective analysis on clinical data of 98 gastric cancer patients who underwent total gastrectomy in China-Japan Union Hospital of Jilin University from January 2013 to December 2015 was carried out, including EME group of 48 cases (according to the mesangial space) and D2 radical group of 50 cases(D2 lymphadenectomy according to the vascular markers). Operations were performed by the same single surgeon team. Surgical indexes and recent efficacy indexes were compared between two groups.</p><p><b>RESULTS</b>General informations pertaining to two groups were comparable (P>0.05). All the operations were performed successfully. Compared with D2 radical group, EME group had a shorter operative time [(155.3±13.6) vs. (171.2±14.9) minutes, P=0.012] and less intraoperative blood loss [(95.1±19.5) vs.(122.6±28.0) milliliters, P=0.011]. There were no significant differences in the number of harvested lymph node (30.8±3.9 vs. 31.5±4.7, P=0.675), time to postoperative bowel function return [(3.2±1.2) vs.(3.9±1.4) days, P=0.179], postoperative hospital stay [(10.9±2.7) vs.(11.3±3.2) days, P=0.788], and the incidence of postoperative complication [8.3% vs. 10.0%, P=0.775]. During the follow-up of 1 year, all the patients had no long-term complications, no tumor recurrence or death.</p><p><b>CONCLUSIONS</b>For advanced gastric cancer, EME result in the same clinical efficacy compared with standard D2 resection. At the same time, EME can shorten the operative time and reduce the intraoperative blood loss, which is a new technology and worthy promoting.</p>

Multidisciplinary comprehensive treatment of gastric cancer / 中华消化外科杂志

At present surgical treatment is a main method for gastric cancer,while multidisciplinary comprehensive treatment for gastric cancer has gradually become the mainstream direction of treatment,which is based on regarding patients as the core part of treatment,aiming at specific disease,building multidisciplinary team and making individualized,standardized,scientific and continuous comprehensive treatment plan.Meanwhile,it can provide the best treatment option and efficacy for particular patients,and raise the diagnostic and treatment skills and academic level.There are obvious promotions in the integration between medical education and health management and the progresses of medicine and science.

Application of three-dimensional laparoscopic system in obturator lymph node dissection of progressive rectal cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To compare the handling and efficacy between three-dimensional(3D) imaging system and two-dimensional(2D) imaging system for laparoscopic surgery of rectal cancer deep obturator lymph node dissection.</p><p><b>METHODS</b>Clinical data of 36 patients who underwent rectal cancer resection and obturator lymph node dissection with 3D or 2D imaging system from January 2013 to May 2014 in our department were retrospectively analyzed. There were 16 cases and 20 cases in 3D group and 2D group respectively. Completion time of obturator lymph node dissection, total operation time, total number of lymph node dissected, number of wrong grasping (more than twice for correct positioning in the same site) times and blood loss during obturator lymph node dissection were compared between two groups.</p><p><b>RESULT</b>The laparoscopic rectal cancer resections were successfully completed without laparotomy in both groups. The completion time of obturator lymph node dissection was (23.5 ± 2.5) min and (25.0 ± 3.0) min respectively (P<0.05); the number of wrong grasping was 5.0 ± 2.0 and 6.0 ± 4.0(P<0.01); the blood loss during obturator lymph node dissection was (15.5 ± 1.5) ml and (17.5 ± 2.5) ml (P<0.01). The differences were all statistically significant. The total operation time of 3D and 2D group was (206.0 ± 26.0) min and (222.5 ± 27.5) min (P<0.05); the total number of lymph node dissected was 24 ± 6 and 21 ± 9 (P<0.05). The differences were statistically significant as well. Six cases in 3D group and 11 cases in 2D group were followed up for 1 year and there was no tumor recurrence or death case.</p><p><b>CONCLUSION</b>3D laparoscopic technique has more obvious advantages as compared with 2D laparoscopic system in rectal cancer deep obturator lymph node dissection, so it is worthy to spread.</p>