Research progression of endoscopic anastomosis technique and digestive tract reconstruction after totally laparoscopic gastrectomy for gastric cancer / 中华胃肠外科杂志

ABSTRACT

With the development of laparoscopic skills and instruments,totally laparoscopic gastrectomy for gastric cancer has become widely used in the clinic,mainly including totally laparoscopic proximal gastric reconstruction,distal gastrectomy for gastric cancer and total gastrectomy. Digestive tract reconstruction is the key procedure of totally laparoscopic gastrectomy for gastric cancer. Totally laparoscopic surgery has less trauma and better visualization than reconstruction in a small incision. At present,feasibility and safety of totally laparoscopic gastrectomy for gastric cancer have been preliminarily confirmed. However,higher level of evidence is needed for the evaluation of long-term oncologic efficacy. In the future,it is possible for patients to best benefit from totally laparoscopic surgery with minimal trauma,safe anastomosis under the principle of radical resection of gastric cancer. The digestive tract reconstruction includes Delta anastomosis (Billroth I),Billroth II anastomosis,and gastrojejunal Roux-en-Y anastomosis in totally laparoscopic distal gastrectomy (TLDG). Billroth I with delta anastomosis has strict indications in TLDG. Gastrojejunal Roux-en-Y anastomosis is now more popular. Billroth II with Braun anastomosis and uncut Roux-en-Y anastomosis is technically easier to carry out in TLDG than Roux-en-Y. Totally laparoscopic proximal gastric reconstruction includes esophagogastric stump anastomosis,esophagogastric tubular anastomosis and interposition jejunostomy. The digestive tract reconstruction includes anastomosis using linear stapler and circular stapler in totally laparoscopic total gastrectomy (TLTG). In order to better serve the clinic,we review the progress of different endoscopic anastomotic techniques and digestive tract reconstruction.