Application value of π-shaped Roux-en-Y esophagojejunostomy in totally laparoscopic total gastrectomy / 中华消化外科杂志

ABSTRACT

Objective To investigate the application value of π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy.Methods The retrospective and descriptive study was conducted.The clinicopathological data of 3 patients who underwent totally laparoscopic total gastrectomy in the Beijing Friendship Hospital of Capital Medical University between October 2016 and March 2017 were collected.Patients received π-shaped Roux-en-Y esophagojejunostomy.Patients who were diagnosed with Ⅱ and above stages by pathological examination underwent postoperative adjuvant chemotherapy with oxaliplatin + tegafur gimeracil oteracil.Observation indicators(1) surgical and postoperative recovery situations;(2) follow-up and survival situations.The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to March 2018.Results (1) Surgical and postoperative recovery situations3 patients underwent successfully totally laparoscopic total gastrectomy,and π-shaped Roux-en-Y esophagojejunostomy was also performed.Case 1 had injury of spleen vessel when No 11 p lymph nodes were dissected and then received successful hemostasis,and case 2 and 3 didn't have complication.Operation time,digestive tract reconstruction time,volume of intraoperative blood loss,time to anal exsufflation and postoperative drainage-tube removal time of case 1,2 and 3 were respectively 376 minutes,290 minutes,284 minutes and 26 minutes,30 minutes,24 minutes and 500 mL,100 mL,200 mL and 2 days,3 days,3 days and 4 days,4 days,5 days.Case 3 with left pleural effusion was cured by puncture and drainage treating,and case 1 and 2 didn't have complication.Three patients were not complicated with anastomotic stoma-related complicaions.Results of postoperative pathological examinationnumber of lymph node dissected and TNM staging of case 1,2 and 3 were respectively 20,17,20 and TlaN0M0 staging,T3N3M0 staging,T1bN0M0 staging.Duration of hospital stay in case 1,2 and 3 was respectively 7 days,8 days and 11 days.(2) Follow-up and survival situations3 patients were followed up,and follow-up time of case 1,2 and 3 was respectively 18 months,16 months,12 months.During the follow-up,case 2 received postoperative adjuvant therapy,and then underwent palliative treatment of Paclitaxel and Xeloda after the case was rechecked out multiple liver metastases at postoperative month 12.Case 1 and 3 had disease-free survival.Conclusion The π-Shaped esophagojejunostomy is safe and feasible for totally laparoscopic total gastrectomy,and it can be used as an alternative to digestive tract reconstruction.