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Objective:To evaluate a two-site secondary sentinel lymph node(SSLN) tracing technology in advanced gastric cancer and its clinical significance.Methods:From Jan 2016 to Dec 2018, 88 advanced distal gastric cancer patients with preoperative confirmed group 5 and group 6 lymph node metastasis were included into a SSLN tracing with nano carbon during the operations to observe imaging range and features. Results were judged by a biopsy.The relationship between SSLN metastasis and parameters such as size, infitrating depth and histological category was evaluated, and compare with the result of one-site SSLN tracing.Results:SSLNs were found in 79 out of 88 patients (90%). Pathological and immunohistochemical examination found SSLNs metastases in 66 cases with a positive rate of 84%, and 139 SSLNs metastases in 164 SSLNs(85%). SSLN positivity was higher in patients with tumor diameter of ≥5 cm, poorer differentiation and deeper infiltration, though not reaching statistical differece, P>0.05. Compared with the result of previously reported one-site SSLN, two site SSLNs detection rate (90% vs. 78%) and SSLNs positive rate (85% vs. 76%) were higher, (χ 2=4.450, 4.078, all P< 0.05); SSLNs positive rate of cases (84% vs. 80%) was higher, the difference was not statistically significant (χ 2=0.335, P>0.05). Conclusion:The application of two-sites SSLN tracing technology can find more metastatic SSLNs in advanced gastric cancer.
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Objective To compare the advantages and disadvantages between Uncut Roux-en-Y anastomosis and Billroth Ⅱ anastomosis in total laparoscopic distal gastrectomy (TLDG) for gastric cancer.Methods The clinical data of 132 patients with distal gastric cancer,who underwent TLDG with Uncut Roux-en-Y anastomosis or Billroth Ⅱ anastomosis in the Affiliated Hospital,Medical School of Ningbo University from February 2015 to December 2017,were retrospectively analyzed.There were 52 patients receiving TLDG with uncut Roux-en-Y anastomosis (RA group) and 80 patients receiving TLDG with Billroth Ⅱ anastomosis (BA group).Results Compared with BA group,the RA group had a longer operation time [(240.6±49.6)min vs.(202.2±36.4)min,F=2.356,P =0.000]and anastomosis time[(49.1 ±5.9)min vs.(47.3±4.2)min,F=4.45,P =0.043],more intraoperative blood loss[(128.9 ± 130.0)ml vs.(79.2 ± 62.5)ml,F=5.66,P =0.004];and short times to first flatus[(2.7±0.8)d vs.(3.0±0.6)d,F=6.61,P =0.031],for liquid diet[(3.7±0.8)d vs.(4.0 ± 0.6)d,F=7.35,P=0.022] and semifluid diet[(4.7 ± 0.8)d vs.(5.0 ± 0.6)d,F=6.43,P=0.013].No perioperative death occurred in two groups;there were no significant differences in length of postoperative hospital stay [(9.4±4.2)d vs.(l0.9±6.4)d,F=0.83,P =0.117]and the incidence of postoperative complication [5.8％(3/52) vs.8.8％(7/80),x2=0.40,P =0.527)].Compared to BA group,alkaline reflex gastritis rate [3.8％(2/52) vs.52.5％(42/80),x2=40.04,P =0.000]and marginal ulcer rate were lower[0(0/52) vs.11.3％(9/80),x2=6.28,P =0.012].There was no significant difference in dumping syndrome rate[0(0/52) vs.3.8％(3/80),x2=0.20,P=0.158] between two groups.Conclusion Uncut Roux-en-Y anastomosis can prevent alkaline reflex gastritis,marginal ulcer and Roux-en-Y stasis syndrome,it may be the preferable technique for reconstruction after total laparoscopic distal gastrectomy.