Safety and feasibility of overlapped delta-shaped anastomosis technique for digestive tract reconstruction during complete laparoscopic right hemicolectomy / 中华肿瘤杂志

Objective: To explore the clinical safety and feasibility of overlapped delta-shaped anastomosis (ODA) in totally laparoscopic right hemicolectomy (TLRHC). Methods: From May 2017 to October 2019, of the 219 patients who underwent TLRHC at the Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 104 cases underwent ODA (ODA group) and 115 cases underwent conventional extracorporeal anastomosis (control group) were compared the surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications. Results: The length of the skin incision in the ODA group was significantly shorter than that in the control group [(5.6±0.9) cm vs. (7.1±1.7) cm, P<0.05], and the time to first flatus and first defecation after surgery in the ODA group was significantly earlier than that in the control group [(1.7±0.7) days vs. (2.0±0.7) days; (3.2±0.6) days vs. (3.3±0.7) days, P<0.05]. While the anastomosis time, operation time, intraoperative blood loss, the time of first ground activities, the number of bowel movements within 12 days after surgery, postoperative hospital stay, tumor size, the distal and proximal margins, the number of lymph node harvested and postoperative TNM stage in the ODA group did not differ from that of the control group (P>0.05). The postoperative complication rates of patients in the ODA group and the control group were 3.8% (4/104) and 4.3% (5/115), respectively, and the difference was not significant (P>0.05). Conclusion: The application of ODA technology in TLRHC can significantly shorten thelength of skin incisionand the recovery time of bowel function, and can obtain satisfactory short-term efficacy.

Analysis of short-term efficacy of overlapping delta-shaped anastomosis in totally laparoscopic left hemicolectomy for digestive tract reconstruction / 中华胃肠外科杂志

Objective: At present, though the laparoscopic delta-shaped anastomosis and overlapping delta-shaped anastomosis have been gradually applied to complete laparoscopic radical resection of left hemicolon cancer, the comparative evaluation of their efficacy has not been mentioned in the published literatures. This study aims to explore the safety, feasibility and short-term efficacy of overlapping delta-shaped anastomosis (ODA) in totally laparoscopic left hemicolectomy. Methods: A retrospective cohort study was performed. The clinical and pathological data of patients who underwent totally laparoscopic left hemicolectomy at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2017 to October 2020 were retrospectively analyzed. The case inclusion criteria were as follows: (1) age of 18-75 years; (2) body mass index (BMI) of 18.5-30 kg/m(2); (3) descending colonic and proximal sigmoid colonic adenocarcinoma was confirmed by preoperative colonoscopy and pathology. The exclusion criteria: (1) multiple primary colorectal cancers; (2) uncontrolled or poorly controlled diabetes mellitus, immune system diseases, or hematological diseases; (3) severe intestinal obstruction; (4) left transverse colonic or splenic flexure colonic adenocarcinoma; (5) distant metastasis of liver, lung and other viscera determined by enhanced computed tomography in the chest, abdomen and pelvis. According to the above criteria, a total of 115 patients with left hemicolon cancer were enrolled. All the patients underwent totally laparoscopic left hemicolectomy. Patients who underwent laparoscopic traditional delta-shaped anastomosis were selected as the control group. Patients who underwent laparoscopic ODA were selected as the ODA group. Effects of these two laparoscopic reconstruction methods on postoperative recovery and perioperative complications were analyzed and compared. Results: A total of 60 patients were enrolled in the ODA group, including 32 males and 28 females, with mean age of (57.3±10.4) years and body mass index (BMI) of (25.0±3.1) kg/m(2). While mean 55 patients were enrolled in the control group, including 31 males and 24 females, with mean age of (56.7±9.9) years and BMI of (24.4±2.9) kg/m(2). There was no statistically significant differences between the two groups in gender, age, BMI, American Society of Anesthesiologist (ASA) classification, TNM staging, preoperative abdominal surgery history, neoadjuvant chemotherapy and nutritional status (levels of hemoglobin, lymphocyte count, prealbumin, and albumin) (all P>0.05). All the patients in both groups received R0 resection without conversion to open laparotomy or conversion to extra-abdominal anastomosis. The digestive tract reconstruction time of the ODA group was significantly shorter than that of the control group [(15.1±1.7) minutes vs. (15.9±2.4) minutes, t=-2.053, P=0.042]. There were no statistically significant differences in the total operation time, intraoperative blood loss, length of skin incision, tumor size, proximal and distal margins, harvested lymph nodes, postoperative first ambulatory time, and postoperative hospital stay (all P>0.05). However, the time to the first flatus and the first defecation in the ODA group was significantly shorter as compared to control group [(1.5±0.5) days vs. (1.7±0.5) days, t=-2.028, P=0.045; (3.1±0.6) days vs. (3.4±0.7) days, t=-2.095, P=0.039], indicating faster intestinal function recovery in patients with ODA. The morbidity of postoperative complication was 6.7% (4/60) in the ODA group and 7.3% (4/55) in the control group and no significant difference was found (χ(2)=0.016, P=0.898). Two cases of incision infection, 1 case of lung infection, and 1 case of intra-abdominal infection occurred in the ODA group, while 3 cases of lung infection and 1 case of intra-abdominal infection occurred in the control group. All these complications were resolved after conservative treatment, and no secondary operation was performed due to complications. Conclusion: Compared with the traditional delta-shaped anastomosis, ODA is associated with a faster recovery of postoperative intestinal function without increasing the morbidity of postoperative complications, and has the satisfactory short-term efficacy.

The Short-term Analysis of Overlapped Delta-shaped Anastomosis in Total Laparoscopic Transverse Colectomy / 中华肿瘤杂志

Objective@#The aim of this study was to explore the clinical safety, feasibility and short-term effect of overlapped delta-shaped anastomosis in total laparoscopic transverse colectomy.@*Methods@#The records, which were based on China National Cancer Center, of 20 and 31 patients who underwent total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis and laparoscopic-assisted transverse colectomy with conventional extracorporeal anastomosis, from March 2017 to May 2018 were reviewed retrospectively. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications were collected and compared.@*Results@#There was no difference between the two groups in overall operation time, anastomosis time and intraoperative blood loss (P>0.05), however, the length of incision was significantly shorter in overlapped delta-shaped group [(4.7±0.6) cm vs. (5.5±1.0) cm, P=0.002]. The time to ground activities, first flatus and postoperative hospitalization did not differ between the two groups (P>0.05). The postoperative visual analogue scale was lower in the overlapped delta-shaped group than the control group on postoperative day 1 (3.7±0.7 vs. 4.2±0.9, P=0.015) and postoperative day 3 (2.7±0.5 vs. 3.2±0.9, P=0.040). The perioperative complication rates were 10.0% and 12.9% in the overlapped delta-shaped group and the control group, respectively, and the difference was not significant (P=0.753).@*Conclusion@#Compared to conventional extracorporeal anastomosis, total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis was a safe and feasible procedure with satisfactory short-term effect, shorter incision and less postoperative pain.

The Short-term Analysis of Overlapped Delta-shaped Anastomosis in Total Laparoscopic Transverse Colectomy / 中华肿瘤杂志

Objective@#The aim of this study was to explore the clinical safety, feasibility and short-term effect of overlapped delta-shaped anastomosis in total laparoscopic transverse colectomy.@*Methods@#The records, which were based on China National Cancer Center, of 20 and 31 patients who underwent total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis and laparoscopic-assisted transverse colectomy with conventional extracorporeal anastomosis, from March 2017 to May 2018 were reviewed retrospectively. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and perioperative complications were collected and compared.@*Results@#There was no difference between the two groups in overall operation time, anastomosis time and intraoperative blood loss (P>0.05), however, the length of incision was significantly shorter in overlapped delta-shaped group [(4.7±0.6) cm vs. (5.5±1.0) cm, P=0.002]. The time to ground activities, first flatus and postoperative hospitalization did not differ between the two groups (P>0.05). The postoperative visual analogue scale was lower in the overlapped delta-shaped group than the control group on postoperative day 1 (3.7±0.7 vs. 4.2±0.9, P=0.015) and postoperative day 3 (2.7±0.5 vs. 3.2±0.9, P=0.040). The perioperative complication rates were 10.0% and 12.9% in the overlapped delta-shaped group and the control group, respectively, and the difference was not significant (P=0.753).@*Conclusion@#Compared to conventional extracorporeal anastomosis, total laparoscopic transverse colectomy with overlapped delta-shaped anastomosis was a safe and feasible procedure with satisfactory short-term effect, shorter incision and less postoperative pain.

The short-term effect analysis of intracorporeal delta-shaped anastomosis in total laparoscopic left hemicolectomy / 中华肿瘤杂志

Objective@#The aim of this study was to explore the clinical safety and feasibility of intracorporeal delta-shaped anastomosis in total laparoscopic left hemicolectomy.@*Methods@#From January 1, 2017 to October 1, 2017, 11 patients who were diagnosed with left colon cancer and underwent total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis were retrospectively enrolled in this study. Clinicopathologic characteristics, surgical and postoperative outcomes were collected and analyzed.@*Results@#The median operation time was 121.8 minutes and the median time for anastomosis was 14.9 minutes. The median intraoperative blood loss was 45.5 ml. The lengths of the upper and lower segments of resection from colon cancer were 11.4 cm and 8.5 cm, respectively. The median number of lymph nodes retrieved was 29.5. The median time to ground activities, time to flatus, time to fluid diet intake and length of hospital stay were 1.4 days, 3.0 days, 3.8 days and 6.9 days, respectively. Only one patient suffered from incision infection during his hospitalization due to preoperative long-term smoking history. No mobility related to the anastomosis such as anastomotic bleeding, stenosis, obstruction and leakage occurred in any patients.@*Conclusion@#Total laparoscopic left hemicolectomy with intracorporeal delta-shaped anastomosis is a safe and feasible procedure with a satisfactory short-term effect.

Long-term prognosis of patients with distal gastric cancer underwent minimally invasive surgery combined with delta-shaped anastomosis / 中国内镜杂志

Objective To evaluate the long-term efficacy of total laparoscopic radical gastrectomy combined with delta-shaped anastomosis in treatment of distal gastric cancer. Methods The clinical data of 128 patients with distal gastric cancer who underwent laparoscopic radical gastrectomy from January 2014 to April 2016 were retrospectively reviewed. According to the different surgical methods, patients were divided into TLDG plus DA treatment group (DA group, 72 cases) and LADG plus TA treatment group (TA group, 56 cases). The operation time, intraoperative blood loss, disconnection time, postoperative exhaust time, lymph node dissection, hospitalization time and postoperative complications were recorded. Patients were followed up monthly by call, to April 2017. Results The blood loss [(55.6 ± 12.5) vs (85.6 ± 15.8) ml] and postoperative exhaust time [(2.5 ± 1.0) vs (4.5 ± 1.5) d] were significantly lower in the DA group than that in TA group (P < 0.05). There was no significant difference between the two groups in the operation time, the removal time, the number of lymph node dissection and the hospitalization time (P > 0.05). The incidence of anastomotic stenosis (0.00％ vs 7.14％), anastomotic fistula (0.00％ vs 8.93％) and anastomotic bleeding (0.00％ vs 7.14％) in DA group was significantly lower than that in TA group (P < 0.05). All the patients were followed up for 16 to 62 months in DA group. 16 patients died of tumor recurrence or metastasis, and the cumulative survival rate was 77.78％. TA group were all effective follow-up, the follow-up time of 15 to 61 months, 14 patients died of tumor recurrence or metastasis, the cumulative survival rate of 75.00％. There was no significant difference in cumulative survival rate between DA group and TA group (P > 0.05). Conclusion In the treatment of distal gastric cancer, there is a certain advantage in the effect of laparoscopic radical gastrectomy plus delta-shaped anastomosis in the treatment of distal gastric cancer over tubular anastomosis.

Application of delta-shaped anastomosis in totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer / 肿瘤研究与临床

Objective To investigate the feasibility and safety of delta-shaped anastomosis in totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer. Methods Clinical data of 26 patients with distal gastric cancer who received total laparoscopic distal gastrectomy with delta-shaped anastomosis from August 2013 to December 2014 were retrospectively analyzed. Results A total of 26 patients were successfully performed by laparoscopic distal gastrectomy with delta-shaped anastomosis. The operative time and delta-shaped anastomosis time was (186 ±28) min and (30 ±24) min respectively. The lengths of upper and lower segment of resection from gastric cancer were (4.9±1.2) cm and (3.5±1.5) cm respectively. Blood loss was (67±39) ml and the number of dissected lymph nodes was (27±11) for every patient. First time to ground activities, first flatus, time to fluid diet and hospital stay were respectively (1.7±0.8) d, (3.5±1.3) d, (4.2±1.6) d and (12±4 ) d. Pathological results showed upper and lower segment of resection cancers were not found. Only 1 patient had gastric small curved stump fistula and recovered after conservative treatment. There were no complications related to the anastomosis in all patients. Conclusion The delta-shaped anastomosis is safe and feasible for totally laparoscopic distal gastrectomy digestive tract reconstruction of gastric cancer with satisfactory short-term efficacy.

Application of delta-shaped anastomosis in billroth-I reconstruction of totally laparoscopic distal gastric cancer radical operation / 重庆医学

Objective To evaluate the safety and short‐term efficacy of delta‐shaped anastomosis in the Billroth‐I reconstruc‐tion of totally laparoscopic distal gastric cancer radical operation (TLDG) .Methods The clinical data in 35 patients with TLDG Delta anastomosis(TLDG group) and 35 patients with laparoscopic assisted distal gastric cancer radical operation (LADG) extraper‐itoneal anastomosis (LADG group) in the gastroenterology department of our hospital from January to December 2014 were ana‐lyzed retrospectively .The intraoperative bleeding volume ,operative time ,gastroenterological function recovery time ,hospitalization duration ,postoperative pathological examination results and hospitalization total cost were compared between the two groups .Re‐sults Seventy cases successfully completed the operation without the cases of conversion to laparotomy and death .The TLDG group had no anastomotic leakage ,bleeding and stenosis after operation ;while the LADG group had 1 case of gastroparesis ,1 case of anastomotic bleeding and 2 cases of anastomotic leakage .The introperative bleeding volume ,tumor size ,number of lymph nodes dissection and distant and proximal incisal margin distance had no statistically significant differences between the two groups (P>0 .05);the operation time ,digestive tract reconstruction time ,first exhaustion time ,time taking liquid diet and postoperative hospital stay time in the TLDG group were significantly shorter than those in LADG group (P< 0 .05) ,but the hospitalization cost was higher than that in the LADG group ,the differences were statistically significant (P<0 .05) .Conclusion The delta‐shaped anasto‐mosis technique is safe and feasible for using in LADG ,moreover has better short‐term effect .

Application value of delta-shaped anastomosis in digestive tract reconstruction following total laparoscopic distal gastrectomy / 中华消化外科杂志

The delta-shaped anastomosis is an emerging operation method in digestive tract reconstruction following total laparoscopic distal gastrectomy (TLDG).With the advantages of small surgical trauma,short anastomosis time and simple manipulation,it has been gradually accepted by surgeons.However,restricted by small manipulation range,restrictive visual range and large anastomotic lumen,there are controversies in complete resection of tumor,intraoperative indexes,postoperative recovery and prevention and treatment of complications about TLDG with delta-shaped anastomosis.In this paper,the operative indications,intraoperative indexes and postoperative recovery of TLDG with delta-shaped anastomosis were reviewed.

Application of R-type jejunal interposition and esophagojejunosto-my by delta-shaped anastomosis after totally laparoscopic radical gastrectomy for gastric stump carcinoma / 中国肿瘤临床

Objective: To evaluate the short-term efficacy of R-type jejunal interposition and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy for gastric stump carcinoma. Methods:Data on 10 patients with gas-tric stump cancer were analyzed retrospectively from January 2013 to August 2014. All the patients received R-type jejunal interposi-tion and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy for gastric stump carcinoma (laparoscope group) in the Lanzhou General Hospital of the Lanzhou Military Area. Laparotomy was performed on 18 cases that com-prised the control group (laparotomy group). The intraoperative and postoperative indicators between these two groups were then com-pared. All the patients were followed-up from 14 to 21 months after the operations. Results:The operations were successfully carried out in all 10 patients (laparoscope group), without performing open operation. The mean operative times, volumes of the intraoperative blood loss, numbers of dissected lymph nodes, frequencies of leaving the bed, days marking the first liquid diet intake, days marking the recovery of gastrointestinal function, and days of hospitalization of the laparoscope group and the laparotomy group were (210.0 ± 30.9) min and (283.9 ± 50.9) min, (90.0 ± 26.7) mL and (277.8 ± 79.1) mL, (19.0 ± 3.6) and (18.8 ± 3.7), (17.3 ± 3.6) h and (75.8 ± 15.7) h, (1.6 ± 0.4) d and (5.7 ± 1.3) d, (3.0 ± 0.8) d and (7.2 ± 1.3) d, and (7.6 ± 1.2) d and (20.8 ± 3.9) d, respectively. Anastomotic stricture, reflux esophagitis, bleeding, leakage, dumping syndrome, or intestinal obstruction was not detected in the laparoscope group. There was no perioperative death. All of the cases exhibited good nutrition situation, and no choking or esophagus burning was reported. Conclusion:R-type jejunal interposition and esophagojejunostomy by delta-shaped anastomosis after totally laparoscopic radical gastrectomy is safe and feasible. The operation can improve the quality of life of patients and induce positive short-term therapeutic effects. Laparo-scopic-assisted radical gastrectomy for gastric stump cancer has the same effect as laparotomy.

Application of delta-shaped anastomosis in totally laparoscopic distal gastrectomy / 中国基层医药

Objective To observe the technical feasibility and safety of delta -shaped (DS)anastomosis in totally laparoscopic distal gastrectomy (TLDG).Methods A retrospective analysis of 9 cases underwent TLDG with D2 lymphadenectomy and DS anastomosis.Results All the patients underwent TLDG with D2 lymphadenectomy and DS anastomosis successfully by the same doctor and his team.The total operative time was (178 ±43)minutes,and the DS anastomosis time was (32 ±8)minutes.All the patients achieved microscopic cancer -free margin and the number of lymph nodes harvested was (27 ±8)per patient.The average time to flatus,time to fluid diet were (3.8 ± 1.7)days and (3.9 ±1.8)days respectivly.One patient developed to fat liquefaction of incision,and one developed to urinary tract infection after the operation.No anastomotic bleeding,anastomotic leakage,anastomotic stenosis or other anastomotic complications happened among all patients.Conclusion DS anastomosis is safe and convenient.It is an ideal choice for reconstruction in TLDG with D2 lymphadenectomy.

The Early Experience with a Totally Laparoscopic Distal Gastrectomy

PURPOSE: In Korea, the number of laparoscopy-assisted distal gastrectomies for early gastric cancer patients has been increasing lately. Although minimally invasive surgery is more beneficial, no reported case of a totally laparoscopic distal gastrectomy has been reported because of difficulty with intracorporeal anastomosis. This study attempts, through our experiences, to determine the feasibility of a totally laparoscopic distal gastrectomy using an intracorporeal gastroduodenostomy in treating early gastric carcinoma. MATERIALS AND METHODS: We investigated surgical results and clinicopatholgic characteristics of eight(8) patients with an early gastric carcinoma who underwent a totally laparoscopic distal gastrectomy at the Department of Surgery, Our Lady of Mercy Hospital, The Catholic University of Korea, between June 2004 and September 2004. The intracorporeal gastroduodenostomy was performed with a delta-shaped ananstomosis by using only laparoscopic linear staplers (Endocutter 45 mm; Ethicon Endosurgery, OH, USA). RESULTS: The operative time was 369.4+/-62.5 minutes (range 275~65 minutes), and the anastomotic time was 45.1+/-14.4 minutes (range 32~0 minutes). The anastomotic time was shortened as surgical experience was gained. The number of laparoscopic linear staplers for an operation was 7.1+/-0.6. The number of lymph nodes harvested was 31.9+/-13.1. There was 1 case of transfusion and no case of conversion to an open procedure. The time to the first flatus was 2.8+/-0.5 days, and the time to the first food intake was 4.1+/-0.8 days. There were no early postoperative complications, and the postoperative hospital stay was 10.0+/-3.9 days. CONCLUSION: A totally laparoscopic distal gastrectomy using an intracorporeal gastroduodenostomy with a delta-shaped anastomosis is technically feasible and can maximize the benefit of laparoscopic surgery for early gastric cancer.