ABSTRACT
Objective To explore the safety and feasibility of the π-shaped esophagojeunostomy in totally laparoscopic total gastrectomy.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 6 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between May 2016 and August 2016 were collected.All the 6 patients underwent totally laparoscopic total gastrectomy,operation procedures included esophagus and stomach mobilization,lymph node dissection,π-shaped esophagojejunostomy,and then laparoscopic digestive tract reconstruction after jejunojejunal anastomosis.Observation indicators included:(1) surgical situations:conversion to open surgery,operation time,time of π-shaped esophagojejunostomy,volume of intraoperative blood loss,number of lymph node dissected;(2) postoperative situations:time for initial out-of-bed activity,time of initial anal exsufflation,time of initial liquid diet intake,time of abdominal drainage tube removal,postoperative complications and duration of postoperative hospital stay;(3) postoperative pathological examination;(4) follow-up and survival situations.Follow-up using outpatient examination was performed to detect the anastomotic stenosis,patients' survival and tumor metastasis and recurrence up to November 2016.The measurement data with normal distribution were represented as (x)±s.Results (1) Surgical situations:all the 6 patients underwent successful totally laparoscopic total gastrectomy using the π-shaped esophagojejunostomy,without conversion to open surgery and perioperative death.Operation time,time of π-shaped esophagojejunostomy,volume of intraoperative blood loss and number of lymph node dissected were respectively (282 ± 49) minutes,(37 ± 9) minutes,(37 ± 8) mL and 39 9.(2) Postoperative situations:time for initial out-of-bed activity,time of initial anal exsufflation,time of initial liquid-diet intake,time of abdominal drainage tube removal and duration of postoperative hospital stay of 6 patients were (44± 38)hours,(72±21)hours,(6.5±l.1)days,(11±7) days and (15±7) days,respectively.Six patients were not complicated with postoperative hemorrhage,duodenal stump fistula and death.One patient with anastomotic fistula was cured by abdominal puncture drainage under guidance of computed tomography (CT),enteral nutrition and antibiotic therapy,and then was discharged from hospital.(3) Postoperative pathological examination:pTNM staging showed that stage Ⅰ A,Ⅱ A,ⅡB and ⅢA were detected in 3,1,1 and 1 patients,respectively.(4) Follow-up and survival situations:6 patients were followed up for 3-6 months,with a median time of 4 months.During follow-up,results of compound meglumine diatrizoate gastrointestinal radiography showed that there were smooth anastomoses,and no tumor recurrence or metastasis and death.Conclusion The π-shaped esophagojejunostomy is safe and feasible in totally laparoscopic total gastrectomy.