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Gastrointestinal reconstruction is an important step in radical gastrectomy for gastric cancer. This article reviews the digestive tract reconstruction methods of total gastrectomy, distal gastrectomy, and proximal gastrectomy, and summarizes various functional preservation gastrectomy techniques that have been continuously developed in recent years. Finally, based on the author′s relevant experience, the surgical methods designed in total gastrectomy and distal gastrectomy are introduced.
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Objective:To investigate the clinical efficacy of total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction.Methods:The data of 18 patients who underwent total laparoscopic resection of gastric stromal tumors with cosmetic suture reconstruction from December 2020 to May 2023 in Zhejiang Provincial People′s Hospital were collected retrospectively, and their clinical efficacy was analyzed.Results:Twelve patients were asymptomatic and the tumor was found during physical examination. All patients underwent total endoscopic resection of gastric stromal tumors with cosmetic suture reconstruction without conversion to open surgery. The time to resume liquid diet was 1-3(1.67±0.35)days, the postoperative hospital stay was 4-12(6.89±2.54)days, and no postoperative complications occurred. Among them, 12 cases were at low risk and 6 cases were at medium risk. CD117 and DOG-1 were positively expressed in all cases. Four out of six patients at medium risk underwent genetic testing, and two patients with c-Kit gene Lys550-Val560 mutation were treated with Gleevec therapy after surgery. Gastrography performed one month after surgery showed that the shape of the stomach was similar to the preoperative shape, with good motility and unimpeded emptying.Conclusions:Total laparoscopic resection of gastric stromal tumors combined with cosmetic suture reconstruction can reduce postoperative gastrointestinal dilatation, esophageal and pyloric stenosis, and has a certain clinical value.
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Objective:To explore the feasibility and therapeutic effect of Roux-en-Y anastomosis through a small incision in laparoscopic distal gastrectomy for gastric cancer.Methods:A retrospective analysis was conducted on the clinical data of 34 patients who underwent laparoscopic distal gastrectomy for gastric cancer through Roux-en-Y anastomosis through small incisions in the Gastrointestinal and Pancreatic Surgery Department of the Zhejiang Provincial People′s Hospital from August 2022 to May 2023.Results:Among the 34 patients, there were 27 males and 7 females, aged (63.6±14.6)years old. All cases underwent surgery successfully and there were no cases of conversion to open surgery. The reconstruction time of the digestive tract was (30.74±3.29)minutes, the intraoperative bleeding volume was (60.29±29.59)ml, the intraoperative lymph nodes were cleaned (32.00±11.00), the incision length of the specimen was (5.88±0.98)cm, the postoperative exhaust time was (1.88±0.73)days, and the postoperative hospitalization time was (11.94±3.87)days. There were no postoperative cases of anastomotic leakage, anastomotic stenosis, bleeding, or unplanned reoperation in patients. After a postoperative follow-up of 3-12 months, there were no recurrence or death cases, and no postoperative reflux cases during the follow-up period.Conclusions:Laparoscopic distal gastrectomy with Roux-en-Y anastomosis through a small incision can effectively reduce postoperative complications, especially the occurrence of postoperative reflux. In addition, this surgical procedure can simplify the surgical steps, shorten the surgical time, promote postoperative recovery, and improve postoperative quality of life.
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Objective:To introduce the operation process of laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction, and evaluate its feasibility, safety during perioperative period, and advantages of anastomosis.Methods:A total of 56 patients with gastric cancer who underwent laparoscopic total gastrectomy assisted by small incision and gastrointestinal reconstruction using tubular instrument anastomosis in esophageal and small bowel reconstruction were selected as study subjects from Zhejiang Provincial People′s Hospital between May 2022 and June 2023. Gender, age, body mass index (BMI), tumor location, tumor stage, tumor type and other related indicators were collected. The main parameters during the operation process were collected, including operation time, anastomosis time, intraoperative blood loss, postoperative recovery status, exhaust time, feeding time, complications related to anastomosis, and length of hospital stay. The differences between other digestive tract reconstruction methods such as Overlap method, reverse puncture method, and handmade anastomosis were compared and analyzed.Results:A total of 56 patients with gastric cancer were included in this study. The anastomosis time of the tubular instrument group was (42.3±15.7)min, which was superior to the handmade anastomosis group ( P<0.05). The operation time of the tubular instrument group was (176.3±25.8)min, which was superior to other methods (all P<0.05). The intraoperative blood loss of the tubular instrument group was (75.68±20.34)ml, which was less than other methods (all P<0.05). The exhaust time of the tubular instrument group was (2.6±0.2)d, which was similar to the Overlap method ( P>0.05), but earlier than the handmade anastomosis method and the reverse puncture method (all P<0.05). The incidence of anastomotic leakage in the tubular instrument group was similar to the handmade anastomosis method, the reverse puncture method, and the Overlap method (all P>0.05). There were no significant differences in postoperative hospital stay, incision infection rate, and other complications related to anastomosis between groups (all P>0.05). Conclusions:The tubular instrument anastomosis method has a shorter operation time and a smaller incision compared to traditional laparotomy surgery. It has the advantages of laparoscopic assistance with intuitive and clear visualization during the operation, while also taking into account the convenience and safety of direct visualization under laparoscopy. It is a surgical method worthy of promotion.
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Objective:To investigate the clinical effect of enteral nutrition support in the transformation therapy of advanced gastric cancer.Methods:Eighty-two patients with advanced gastric cancer treated by transformation in Zhejiang Provincial People′s Hospital from September 2019 to August 2021 were analyzed retrospectively. 41 patients in the observation group were treated with enteral nutrition support on the basis of routine transformation treatment; 41 patients in the control group received only routine transformation treatment. The nutritional related indexes such as prealbumin, total serum protein and albumin and immune related indexes such as CD4 + , CD8 + , CD4 + /CD8 + were detected before treatment and on the 7th day after the end of 3-cycle transformation treatment, and the above indexes and transformation success rate of the two groups were compared. Results:There was no significant difference in prealbumin, total serum protein, albumin, CD4 + , CD8 + , CD4 + /CD8 + between the two groups before treatment (all P>0.05). On the 7th day after three cycles of transformation treatment, the above indexes in the observation group were higher than those in the control group, with significant difference (all P<0.05). The success rate of transformation in the observation group was higher than that in the control group ( P<0.05). Conclusions:The rational use of enteral nutrition support in the transformation treatment of patients with advanced gastric cancer can significantly improve the nutritional status and immune function of patients, increase the tolerance to chemotherapy and improve the success rate of transformation.
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Objective:To verify the transforming therapeutic efficacy of apatinib combined with oxaliplatin + tegiol (SOX regimen) in advanced gastric cancer with peritoneal metastasis.Methods:Using the method of descriptive case series study, the data of gastric cancer patients with peritoneal metastasis treated in Zhejiang Provincial People′s Hospital and Shulan (Hangzhou) Hospital from March 2016 to August 2021 were collected and treated with apatinib combined with SOX regimen. Oxaliplatin 130 mg/m 2, intravenous drip, day 1; Apatinib mesylate tablets 500 mg/d, oral, once a day, 1-21 days; Teggio: calculate the dosage according to the body surface area (<1.25 m 2, 40 mg; 1.25-1.50 m 2, 50 mg; >1.50 m 2, 60 mg). Take it orally for 1-14 days, twice a day. From the first day of chemotherapy, a cycle of 3 weeks. The short-term efficacy was evaluated every 2 cycles. After that, the multidisciplinary treatment team will decide whether the conversion operation can be accepted. When the requirements of surgical resection were met, the operation will be carried out after 1 cycle of drug withdrawal. Results:The median survival time (MST) of 23 patients was 14.1 months (95% CI: 12.3-16.4); The median overall survival (OS) after transformation therapy was 19.1 months (95% CI: 15.5-22.8). After transformation therapy, 14 cases of partial remission (PR), 3 cases of stable disease (SD) and 6 cases of progression disease (PD) in 23 patients, and the objective remission rate (ORR) was 73.9%(17/23). 12(52.2%) patients underwent surgery after transformation therapy. The 1-year OS of 12 patients was (17.0±1.5)months; Among them, 5 cases underwent R0 resection, and the R0 resection rate was 5/12. Conclusions:Transformation treatment with apatinib combined with oxaliplatin + tegio (SOX regimen) in advanced gastric cancer can achieve a high R0 resection rate with better conversion effect.