Comparison of the effects of different digestive tract reconstruction methods in laparoscopic assisted radical gastrectomy for distal gastric cancer / 中国综合临床

Objective:To evaluate the feasibility, safety and efficacy of uncut Roux-en-Y anastomosis, Roux-en-Y anastomosis and Billroth Ⅱ plus Braun anastomosis in laparoscopic-assisted distal gastrectomy for distal gastric cancer.Methods:In the retrospective cohort study, 71 cases of laparoscopic-assisted distal gastrectomy for distal gastric cancer from May 2016 to October 2019 in Tangshan Union Medical College Hospital were selected as the study subject. According to the different reconstruction methods of digestive tract, they were divided into: non disconnected Roux-en-Y anastomosis group (Uncut RY group, 29 cases); Roux-en-Y anastomosis group (RY group, 24 cases); Billroth Ⅱ-braun anastomosis group (B Ⅱ-Braun group, 18 cases). The operation time, digestive tract reconstruction time, intraoperative blood loss, the time to flatus, length of hospital stay, incidence of complication and the changes of nutritional index 1 year after surgery were observed. SPSS 18.0 software was used process the data, the measurement data conforming to normal distribution by Kolmogorov-Smirnov test was expressed by xˉ± s deviation, the measurement data dose not meet the normal distribution was expressed by the median (interquartile range) ( M( Q1, Q3)).Analysis of variance was used to compare the measurement data of normal distribution; Nonparametric rank sum test was used for the comparison between measurement data groups with non normal distribution; Count data were expressed in cases (%), and χ 2 test or Fisher exact probability method was used for composition comparison between groups. Results:In Uncut group, RY group and B Ⅱ-Braun group, the operation time were (196.0±28.8) min, (201.0±28.5) min and (186.4±26.1) min, respectively, the digestive tract reconstruction time were (56.2±13.9) min, (57.8±12.9) min and (51.5±10.0) min, respectively,the intraoperative blood loss were (285.2±85.4) mL, (280.1±78.4) mL and (273.3±79.6) mL, respectively, the time to flatus were (52.5±14.4) h,(53.9±14.6) h and (46.2±9.4) h, respectively, the length of hospital stay were (12.6±2.8) d, (12.1±3.0) d and (12.8±2.6) d, respectively, there were no significant differences among the three groups ( F values were 1.41, 1.33, 0.12, 1.89 and 0.35, respectively; P values were 0.251, 0.271, 0.890, 0.158 and 0.709, respectively). Postoperative complications in Uncut group, RY group and BⅡ-Braun group: The number of cases of anastomotic leakage was 0, 1 and 1, respectively. The number of cases of abdominal bleeding was 1, 1 and 0, respectively. The number of cases of bile reflux gastritis was 2, 1 and 5, respectively, and the number of cases of anastomotic ulcer was 0, 0 and 1, respectively. There were no significant differences among the three groups (Fisher's exact test, P values were 0.510,1.000, 0.063 and 0.254, respectively). The number of cases of Roux-en-Y retention syndrome was 0, 6 and 0, respectively. There were significant differences among the three groups (Fisher's exact test, P=0.001). Nutritional index: the weight loss were 4.00 (2.00, 5.50) kg, 3.00 (1.25,4.75) kg and 3.00 (1.75,4.25) kg respectively, decreases of hemoglobin level were (5.62±8.20) g/L, (6.63±6.84) g/L and(5.33±7.79) g/L, respectively, decreases of albumin level were 1.00 (-2.50, 7.00) g/L, 3.00 (-1.25, 6.75) g/L and 6.00 (-3.25,7.50) g/L, respectively. There were no significant differences among the three groups (Statistic value were χ 2=1.42, F=0.18 and χ 2=2.43, respectively, P values were 0.492,0.839 and 0.297, respectively). Conclusion:As a digestive tract reconstruction method for radical resection of distal gastric cancer, uncut Roux-en-Y anastomosis can reduce the incidence of Roux-en-Y retention syndrome without increasing the operation risk and affecting the postoperative nutritional status. It is a safe and feasible gastrointestinal tract reconstruction method.

Effect observation of uncut Roux-en-Y anastomosis in laparoscopic assisted radical gastrectomy for distal gastric cancer / 中国综合临床

Objective:To investigate the effect of uncut Roux-en-Y anastomosis in laparoscopic assisted radical gastrectomy for distal gastric cancer.Methods:The clinical data of 53 patients with distal gastric cancer treated by surgery in Tangshan Union Medical College Hospital from May 2016 to October 2019 were analyzed retrospectively.The operation method was laparoscopic assisted radical gastrectomy for distal gastric cancer.The anastomosis methods were uncut Roux-en-Y anastomosis in 29 cases (uncut group) and Roux-en-Y anastomosis in 24 cases (traditional group). The operation time, digestive tract reconstruction time, the time to flatus, length of hospital stay, incidence of complication and one year followed up results were compared between the two groups.Results:The operation time was (196.0±28.8) min, anastomotic time was (56.1±13.8) min, postoperative exhaust time was (52.5±14.4) h, postoperative hospital stay was (12.5±2.8) d in the uncut group, and (201.0±28.5) min, (57.8±12.9) min, (53.9±14.6) h, (12.0±3.0) d in the traditional group.There was no significant difference between the two groups ( P values were 0.534, 0.664, 0.717 and 0.557, respectively). Postoperative complications: anastomotic leakage was 0(0/29), abdominal bleeding was 3.4% (1/29), alkaline reflux gastritis was 6.9% (2/29) in the uncut group and 4.2% (1/24), 4.2% (1/24) and 4.2% (1/24) in the traditional group respectively.There was no significant difference between the two groups ( P values were 0.453, 1.000 and 1.000, respectively). The incidence of Roux-en-Y stasis syndrome was 0 (0/29) in the uncut group and 25.0% (6/24) in the traditional group.There was significant difference between the two groups ( P=0.006). One case in the uncut group was found recanalization 8 months after operation, the patient underwent reoperation, the method of anastomosis was changed to traditional Roux-en-Y anastomosis.The patient′s symptoms of reflux and hearburn improved significantly after operation. Conclusion:As a digestive tract reconstruction method for radical gastrectomy of distal gastric cancer, uncut Roux-en-Y anastomosis is safe and feasible, and can avoid Roux-en-Y stasis syndrome.

Comparative study between assisted laparoscopic and open D2 distal gastrectomy for gastric cancer

Background: Although laparoscopic gastrectomy has been in use for many years, there was great debate for its technical feasibility and oncological safety. However, with recent advancements of laparoscopic surgical instruments and the accumulation of operative experience, laparoscopic gastrectomy becomes more feasible, and laparoscopic D2 lymphadenectomy has been achieved. Methods: This study was prospectively conducted from April 2016 to September 2018 on 40 patients presenting with distal gastric cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study performed radical distal gastrectomy with D2 lymphadenectomy aiming for cure. The patients were divided into 2 groups: group A (20 patients operated upon with open gastrectomy (OG) technique) and group B (20 patients operated upon with the laparoscopic gastrectomy (LG) technique). Both groups were compared in this study regarding operative details, short term post-operative complications and pathological results.Results: The mean operative time in OG was shorter than LG (p value: 0.04), while there was significant difference between both groups regarding blood loss, mean blood loss in OG was 420.8±87.6 ml and in LG was 283.4±45.9ml, parenteral analgesic requirement was significantly less in LG than OG (p value: 0.04) while no significant difference regarding Intra-operative complications and pathological results.Conclusions: Assisted Laparoscopic distal gastrectomy with D2 lymphadenectomy is feasible and safe with less post-operative pain and short hospital stay.

Application of enhanced recovery after surgery in total laparoscopic uncut Roux-en-Y gastrojejunostomy / 中国现代普通外科进展

Objective:To evaluate the safety and feasibility of enhanced recovery after surgery (ERAS) in total laparoscopic Uncut Roux-en-Y gastrojejunostomy after distal gastrectomy.Methods:The clinical data of 42 patients who were divided into ERAS group (n=20) and control group (n=22) were collected.Observation indicators included operation condition,postoperative clinical indexes and postoperative serum stress indexes.Measurement data with normal distribution were presented as-x±s and analyzed by T test.Count data were analyzed by the chi-square test.Results:The operative time,volume of intraoperative blood loss and number of patients with conversion to open surgery shown no statistically significant difference between the 2 groups(P＞0.05).Postoperative clinical indexes:time for initial anus exhaust,time for initial liquid diet intake,time for out-of-bed activity,duration of hoSpital stay of patients without complications in the ERAS group were lower than in the control group,with statistically significant differences between the 2 groups (P＜0.05).But the time to initial defecation,time of abdominal drainage-tube removal and the early postoperative complications between the 2 group had no statistically difference(P＞0.05). Postoperative complications:at the first days and the third days after operation,WBC,CRP and I L-6 in ERAS group were lower than in the control group,the differences were statistically significant (P＜0.05).Conclusion:The perioperative ERAS program in total laparoscopic Uncut Roux-en-Y gastrojejunostomy after distal gastrectomy is safe and effective and should be popularized,meanwhile,it can also reduce duration of hospital stay and improve the comfortable degree and satisfaction of patients.

Analysis on clinical efficacy of minimally invasive distal gastric cancer surgery combined with D2 lymph node dissection / 局解手术学杂志

Objective To explore the clinical effect of minimally invasive distal gastric cancer surgery combined with D2 lymph node dissection. Methods From September 2010 to September 2012,95 cases of gastric cancer surgically treated from our hospital were selected. Among them,2 cases were converted to laparotomy by abdominal cavity,and a total of 93 patients were included in the study. According to dif-ferent surgical methods,there were 43 cases in the observation group and 50 cases in the control group. The observation group was treated with minimally invasive distal gastric cancer surgery combined with D2 lymph node dissection,and the control group was treated with open surgery combined with D2 lymph node dissection. The bleeding volume,ambulation time,operative time,hospitalization time,lymph node dissection and postoperative complications were compared between the two groups. The recurrence,metastasis and mortality during 1 year,3 years and 5 years follow-up were also compared. Results The bleeding volume in the observation group was less than that in the control group,and the off-bed activity occurred earlier than that in the control group. The hospitalization time was shorter in the observation group than in the control group(P<0. 05),but there was no significant difference in operative time between the two groups(P>0. 05). There was no statistical differ-ence between the number of lymph nodes in the first station, the number of lymph nodes in second stations and the total number of lymph nodes in the two groups(P>0. 05). The incidence of postoperative complications in the observation group(6. 98％) was lower than that of the control group (22. 00％)(P<0. 05). The two groups were followed up for 1,3 and 5 years,and the recurrence rate and mortality rate were low(P>0. 05). Conclusion minimally invasive distal gastric cancer surgery combined with D2 lymph node dissection has significant clinical effect,less blood loss,quicker postoperative recovery and fewer complications,as well as less recurrence and metastasis and death in long-term follow-up.

Differences of Lymph Node Metastasis Between Early Proximal and Distal Gastric Cancer and Indication of Endoscopic Resection / 胃肠病学

Background:In recent years,a rising incidence of proximal gastric cancer(PGC)has been reported,in contrast to a declining trend of distal gastric cancer(DGC). Differences in clinicopathological features between PGC and DGC have also been reported. Aims:To investigate the differences of lymph node metastasis between early PGC and DGC and the indication of endoscopic resection. Methods:The clinical data of 420 early gastric cancer patients(101 PGC patients and 319 DGC patients)who underwent curative gastrectomy from June 2013 to June 2016 at the Affiliated Drum Tower Hospital of Nanjing University Medical School were retrospectively analyzed. Clinicopathological features were compared between early PGC and DGC,and risk factors of lymph node metastasis were analyzed. Results:The differences in gender,age, histological differentiation,ulceration and lymph node metastasis were significant between early PDG and DGC patients (P<0.05). Tumor site,tumor size,depth of invasion,histological differentiation and vascular invasion were significantly correlated with lymph node metastasis by univariate analysis(P<0.05). Multivariate analysis revealed that tumor site, depth of invasion,histological differentiation and vascular invasion were independent risk factors for lymph node metastasis (P<0.05). The lymph node metastasis rate of mucosal,differentiated and vascular invasion negative PGC was 2.8%, which was lower than that of DGC(8.3%). Conclusions:The clinicopathological features of early PGC are different from those of early DGC. Patients with mucosal,differentiated and vascular invasion negative PGC are more suitable for endoscopic resection.

Clinical value and safety of total laparoscopic gastro-duodenal triangle anastomosis / 中国现代普通外科进展

Objectives:To analyze the clinical value and safety of total laparoscopic gastro-duodenal triangle anastomosis in radical surgery of distal gastric cancer.Methods:Sixty patients with gastric cancer treated from May 2013 to August 2016 were selected as study subjects and randomly divided into experimental group and control group,with 30 cases in each group.The experimental group was given laparoscopic radical gastrectomy for gastro-duodenal anastomosis,while the control group was given laparoscopic auxiliary distal gastrectomy for radical gastrectomy.The clinical efficacy and safety of the two groups were compared.Results:Compared with the control group,the operation time of the experimental group was longer,the blood loss was less,the distal margin of the tumor was longer,the postoperative pain score was lower and the dosage of analgesics was less (P＜0.05);There was no significant difference in TNM stage and Lauren classification between the two groups(P＞0.05).The incidence of postoperative complications in the experimental group was 6.67％,which was lower than that in the control group(10.0％),but the difference was no Statistical significance (P＞0.05).Conclusion:Total laparoscopic distal gastric cancer Gastro-duodenal triangle anastomosis is effective and safe,and worthy of clinical application.

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.

A comparative analysis of the incidence rates of esophageal cancer and upper diges-tive tract cancer in Cixian County, Hebei Province, China / 中国肿瘤临床

Objective:To investigate the incidence rate of upper digestive tract cancer in Cixian, China, a particular area with high inci-dence of esophageal cancer. Methods:Statistical analysis was performed on the 2003-2012 incidence data of upper digestive tract can-cer in Cixian. The annual incidence rate, Chinese population standardized incidence rate (the bid rate), and structure of world popula-tion standardized incidence rate (referred to as the world standard rate) were calculated. The incidence data were divided into two groups according to period (2003-2007 and 2008-2012), and different age groups were compared. Results:From 2003 to 2012, the in-cidence of upper gastrointestinal cancer was 165.36/10 million. The 2003-2007 crude incidence rate was 171.55/10 million), whereas 2008-2012 crude incidence rate was 151.41/10 million which has reduced over the last five years. Esophageal cancer incidence from 2003 to 2012 had a crude incidence rate of 108.05/10 million during the two periods (from 2003 to 2007, the incidence rate was 116.87/10 million;and from 2008 to 2012, 99.58/10 million), the crude incidence rate of the latter 5-year period has declined obvious-ly. From 2003 to 2012, the overall crude incidence rate of cardia cancer was 31.21/10 million, comparison of two peaiods (from 2003 to 2007 was 29.11/10 million, and 2008-2012, 33.23/10 million) indicated that the level of measurement of the latter period in-creased. At the same period, the overall incidence rate of gastric cancer was 26.10/10 million, comparison of the two periods (2003-2007 the crude incidence rate was 25.57/10 million, 2008-2012 was 26.60/10 million) indicated that the level of the parameter in the latter 5 years increased slightly. Conclusion:The incidence of esophageal cancer in Cixian decreased significantly, but the area remains to have the highest incidence rate of cardiac cancer morbidity. The incidence rate of distal gastric cancer increased significantly in males but decreased slightly in females, which suggests that early diagnosis and treatment of gastric cardia and distal stomach cancer is extremely important.

A comparative study between laparoscopic-assisted and open distal radical operation for advanced gastric cancer / 中国医师进修杂志

Objective To compare the effect of laparoscopic-assisted and open distal gastric cancer radical operation for advanced gastric cancer and evaluate the feasibility and short-term outcomes of laparoscopic-assisted distal gastric cancer radical operation.Methods The clinical data of 198 patients from January 2007 to December 2011 were analyzed retrospectively.Ninety-one patients who underwent laparoscopic-assisted distal gastric cancer radical operation was in laparoscopy group,and 107 patients who underwent open distal gastric cancer radical operation was in open operation group.Results The operative time in laparoscopy group was significantly longer than that in open operation group [(260.08 ± 26.28) min vs.(231.74 ± 17.33) min],and intraoperative blood loss volume,incision length,recovery of bowel activity,time of stay in hospital and recovery eating were significantly shorter than those in open operation group [(152.13 ± 51.05) nl vs.(348.00 ± 110.36) ml,(5.02 ± 0.82) cm vs.(19.13 ± 1.57) cm,(2.79 ± 0.75) d vs.(4.49 ± 1.09) d,(9.97 ± 2.08) d vs.(12.15 ± 2.46)d,(6.91 ± 1.44) d vs.(7.45 ± 1.08) d,P＜ 0.05].The total number of lymph nodes and postoperative complication had no significant difference between two groups (P ＞ 0.05).Conclusions The laparoscopic-assisted distal gastric cancer radical operation for advanced gastric cancer is safe and feasible.It has better short-term outcomes.

The feasibility and advantages of billroth-I reconstruction in distal gastric cancers following resection.

Background: Gastric carcinomas are common malignancies in southern India and distal stomach remains the commonest site in low socio economic groups. Surgery still remains an important modality of treatment to achieve local control and also relieve obstructive symptoms. In this study we investigated the feasibility of performing a gastrectomy and billroth-1 type of anastomosis in a rural cancer center setting, with parameters like adequacy of margins, ease of anastomosis and its functional results were analysed Materials and Methods: Eight patients presenting to a rurally based cancer center underwent a distal gastrectomy and billroth-1 type of anastomosis for continuity restoration Results: All the patients had adequate proximal and distal marg. The surgical time varied between-hrs. The anastomosis was constructed without any tension on bowel ends in all patients. The average time to start oral feeds varied between- None of the patients showed symptoms of bile reflux nor dumping. The average hospital stay varied between- Conclusions: Billroth-1 anastomosis is a physiologically more natural way of restoring continuity following a gastrectomy and it is a procedure which would be technically more simpler and decrease per and post operative complications and allow speedier post operative recovery following surgery on distal gastric cancers.

Indication of Dissection of the 14v Lymph Node in Advanced Distal Gastric Cancer

PURPOSE: According to the 2nd English Edition of the Japanese Gastric Cancer Association (JGCA) in 1998, in case of distal gastric cancer, the 14v (superior mesenteric vein) lymph node (LN) is included in the N2 group. However, in Korea, a modified radical gastrectomy is performed, and a 14v LN dissection is not done as a routine procedure. Thus, we investigated the rate of metastatic 14v LNs, evaluated the necessity of dissection of the 14v LN, and searched for indications of 14v LN dissection. MATERIALS AND METHODS: From April 2004 to August 2005, we enrolled the patients who were diagnosed as having advanced gastric cancer in the distal third portion of the stomach. We performed a distal gastrectomy with D2 lymph node dissection as defined in the 2nd English edition of the JGCA classification. We calculated the positive rate of metastatic LNs of each station and analyzed the relationship between the positive rates of No.6 LNs and 14v LNs. We also compared the positive 14v LN group with the negative 14v LN group. RESULTS: The total number of patients was 50, the mean age was 56 (range 30~80) years, and sex ratio (Male/Female) was 1.63 : 1. In 47 (94%) cases, distal a gastrectomy with gastroduodenostomy was done, and in the remaining 3 (6%) cases, a distal gastrectomy with gastrojejunostomy was done. The most frequently metastatic LNs were nos. 3 and 6 (54%). The metastatic rate of the 14v LN was 10%, which was similar to that of LN no. 9. In the comparison of the 14v positive group with the 14v negative group, there were significant differences in the numbers of metastatic LNs (mean 25.4 vs 4.91, P<0.001) and the numbers of metastatic no. 6 LNs, (mean 6.8 vs 1.42, P<0.001), and if no. 6 LNs were metastatic, the possibility of metastasis to the 14v LN was 19.2%. In the 14v positive group, all cases were more than stage 3 by the UICC 6th edition. CONCLUSION: In cases of advanced cancer with metastasis to the no. 6 LN, there was a good chance of metastasis to the 14v LN. Thus, in the operative field, if the tumor is advanced to more than stage 3 by the UICC classification and the no. 6 LN is metastatic, a 14v LN dissection is necessary. However, the usefulness of a 14v LN dissection should be evaluated prospectively through an analysis of tumor recurrence and long-term survival.

Analysis of No.12b Lymph Node Dissection for 60 Cases of Advanced Distal Gastric Cancer Accepting D_2 Lymphadenectomy / 中国普外基础与临床杂志

Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer,and the relation between No.12b lymph node metastasis and clinicopathologic factors.Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively,both of which were all plus No.12b lymph node dissections.The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed.Results No death attributed to operation or severe operative complications were found.There were 12 cases(20.00%) with No.12b lymph node metastasis.The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types,N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25%(10/32),30.30%(10/33) and 29.73%(11/37),which were significantly higher than those in Borrmann Ⅰ-Ⅱ types(7.14%(2/28)),N0-1(7.41%(2/27)) and T1-2(4.35%(1/23)) respectively(P