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Liu W, Guo Y, Qiu Z, Liu X, Zhang J, Sun Z. A Modified Purse-String Stapling Technique for Intracorporeal Circular Stapled Esophagojejunostomy During Laparoscopic Total Gastrectomy: Comparison with Extracorporeal Reconstruction Technique. J Laparoendosc Adv Surg Tech A 2023; 33:1074-1080. [PMID: 37787916 DOI: 10.1089/lap.2023.0253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background: Intracorporeal esophagojejunostomy (EJ) in the context of laparoscopic total gastrectomy remains a complex and technically demanding procedure. We have previously introduced a novel method of intracorporeal circular stapled EJ utilizing a conventional purse-string suture instrument. Since May 2018, we have refined this technique, and the aim of this study was to assess its safety and efficacy. Methods: Between May 2018 and June 2022, we enrolled 92 patients who underwent laparoscopic total gastrectomy with the modified intracorporeal reconstruction method. In addition, between March 2014 and June 2022, we enrolled 121 patients who underwent the procedure with the extracorporeal reconstruction method. We retrospectively collected and compared the clinical data of these 2 patient cohorts. Results: Intracorporeal reconstruction group experienced lower postoperative pain scores (2.7 ± 1.3 versus 4.5 ± 1.4, P = .032), reduced administration of analgesics (3.1 ± 2.2 versus 5.0 ± 3.5, P = .041), and shorter postoperative hospital stays (4.9 ± 2.3 versus 6.3 ± 3.5, P = .045) compared with the extracorporeal reconstruction group. In addition, anastomotic time and postoperative pain score were not increased in the overweight patients in the intracorporeal reconstruction group. Anastomotic leakage occurred in 2 (2.2%) patients in the intracorporeal reconstruction group and 4 (3.3%) patients in the extracorporeal reconstruction group. Anastomotic stricture occurred in 1 (1.1% and 0.8%) patient in each group. There was no significant difference in the overall postoperative complication rate between the 2 groups. Conclusions: The modified intracorporeal purse-string stapling technique for EJ during laparoscopic total gastrectomy is a safe and viable option, exhibiting less invasiveness and comparable outcomes to the extracorporeal reconstruction method, especially suitable for obese patients.
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Affiliation(s)
- Weiguo Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yongfang Guo
- Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhigang Qiu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xichun Liu
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianli Zhang
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenqing Sun
- Department of General Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Yan Y, Wang D, Mahuron K, Wang X, Lu L, Zhao Z, Melstrom L, Li C, Paz IB, Liu J, Fong Y, Li W, Fu W, Woo Y. Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers. Ann Surg Oncol 2023; 30:6718-6727. [PMID: 37442910 PMCID: PMC10506935 DOI: 10.1245/s10434-023-13771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/03/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial. We evaluated outcomes of minimally invasive esophagojejunostomy after laparoscopic or robotic total gastrectomies. METHODS We retrospectively reviewed MITG patients between 2015 and 2020 at two high-volume centers in China and the United States. Eligible patients were divided into groups by different reconstruction methods. We compared clinicopathologic characteristics, postoperative outcomes, including complication rates, overall survival rate (OS), disease-free survival rate (DFS), and patient-reported QoL. RESULTS GC patients (n = 105) were divided into intracorporeal esophagojejunostomy (IEJ, n = 60) and extracorporeal esophagojejunostomy (EEJ, n = 45) groups. EEJ had higher incidence of wound infection (8.3% vs 13.3%, P = 0.044) and pneumonia (21.7% vs 40.0%, P = 0.042) than IEJ. The linear stapler (LS) group was inferior to the circular stapler (CS) group in reflux [50.0 (11.1-77.8) vs 44.4 (0.0-66.7), P = 0.041] and diarrhea [33.3 (0.0-66.7) vs 0.0 (0.0-66.7), P = 0.045] while LS was better than CS for dysphagia [22.2 (0.0-33.3) vs 11.1 (0.0-33.3), P = 0.049] and eating restrictions [33.3 (16.7-58.3) vs 41.7 (16.7-66.7), P = 0.029] at 1 year. OS and DFS did not differ significantly between LS and CS. CONCLUSIONS IEJ anastomosis generated better results than EEJ. LS was associated with a better patient eating experience, but more diarrhea and reflux compared with CS. Clinical and patient-reported outcomes show the superiority of IEJ with the LS reconstruction method in MITG for GC.
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Affiliation(s)
- Yongjia Yan
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Daohan Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Kelly Mahuron
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Xi Wang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Lu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhicheng Zhao
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Laleh Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Chuan Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - I Benjamin Paz
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Jian Liu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Weidong Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
| | - Yanghee Woo
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
- Cancer Immunotherapeutics Program, Beckman Research Institute, City of Hope, Duarte, CA, USA.
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Aiolfi A, Sozzi A, Bonitta G, Lombardo F, Cavalli M, Campanelli G, Bonavina L, Bona D. Short-term outcomes of different esophagojejunal anastomotic techniques during laparoscopic total gastrectomy: a network meta-analysis. Surg Endosc 2023:10.1007/s00464-023-10231-6. [PMID: 37400689 DOI: 10.1007/s00464-023-10231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/17/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Different techniques have been described for esophagojejunostomy (EJ) during laparoscopic total gastrectomy (LTG) for gastric cancer. Linear stapled techniques include overlap (OL) and functional end-to-end anastomosis (FEEA) while single staple technique (SST), hemi-double staple technique (HDST), and OrVil® are circular stapled approaches. Nowadays, the choice among techniques for EJ depends on operating surgeon personal preference. PURPOSE To compare short-term outcomes of different EJ techniques during LTG. METHODS Systematic review and network meta-analysis. OL, FEEA, SST, HDST, and OrVil® were compared. Primary outcomes were anastomotic leak (AL) and stenosis (AS). Risk ratio (RR) and weighted mean difference (WMD) were used as pooled effect size measures, whereas 95% credible intervals (CrI) were used to measure relative inference. RESULTS Overall, 3177 patients (20 studies) were included. The technique for EJ was SST (n = 1026; 32.9%), OL (n = 826; 26.5%), FEEA (n = 752; 24.1%), OrVil® (n = 317; 10.1%), and HDST (n = 196; 6.4%). AL was comparable for OL vs. FEEA (RR = 0.82; 95% CrI 0.47-1.49), OL vs. SST (RR = 0.55; 95% CrI 0.27-1.21), OL vs. OrVil® (RR = 0.54; 95% CrI 0.32-1.22), and OL vs. HDST (RR = 0.65; 95% CrI 0.28-1.63). Similarly, AS was similar for OL vs. FEEA (RR = 0.46; 95% CrI 0.18-1.28), OL vs. SST (RR = 0.89; 95% CrI 0.39-2.15), OL vs. OrVil® (RR = 0.36; 95% CrI 0.14-1.02), and OL vs. HDST (RR = 0.61; 95% CrI 0.31-1.21). Anastomotic bleeding, time to soft diet resumption, pulmonary complications, hospital length of stay, and mortality were comparable while operative time was reduced for FEEA. CONCLUSIONS This network meta-analysis shows similar postoperative AL and AS risk when comparing OL, FEEA, SST, HDST, and OrVil® techniques. Similarly, no differences were found for anastomotic bleeding, operative time, soft diet resumption, pulmonary complications, hospital length of stay and 30-day mortality.
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Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy.
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Luigi Bonavina
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso n.173, 20151, Milan, Italy
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Aslan M, Topgül K. A novel, easier and safer alternative method for oesophagojejunal reconstruction after totally laparoscopic total gastrectomy. Surg Endosc 2023; 37:4075-4083. [PMID: 36952045 DOI: 10.1007/s00464-023-09992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 02/25/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND This study presents a novel laparoscopic modified overlapping oesophagojejunostomy anastomosis method which consists of self-pulling and latter transection to perform a safer anastomosis, describes the anastomosis technique in detail and reveals its short-term outcomes. METHODS Forty-five patients underwent totally laparoscopic total gastrectomy using the self-pulling and oesophagus latter-cut overlap method anastomosis for gastric cancer from January 2019-2022. During the self-pulling phase, the oesophagus was ligated at the level of the gastroesophageal junction or above and dragged down by a ligature rope to mobilise up to 5-6 cm. An entry hole was created on the right side of the oesophagus, and a nasogastric tube was taken out through the hole and tip of the tube was used as a guide for the endoscopic linear stapler to decrease the risk of entering the false lumen and creating a side-to-side anastomosis. The oesophagus was then latter-transected by a second endoscopic linear stapler. The common entry hole was closed using a hand-sewing method. Clinicopathological characteristics and surgical outcomes were collected and retrospectively evaluated. RESULTS The mean anastomosis duration was 27 min. The morbidity rate was 4.4%. Only two patients experienced postoperative complications but subsequently recovered conservatively. None of the patients suffered anastomotic leak or stricture. CONCLUSIONS Self-pulling and latter transection-based overlapping anastomosis is a simple and reliable approach that overcomes most of the limitations of standard overlap method and provides satisfactory surgical outcomes.
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Affiliation(s)
- Mehmet Aslan
- Surgical Oncology Consultant, Department of Surgical Oncology, VM Medicalpark Hospital, Kocaeli, Turkey.
- , Tüysüzler Mahallesi, gülibrişim Sokak, No: 16/b1, Kıbrıs villaları 3. Etap 41100 İzmit, Kocaeli, Turkey.
| | - Koray Topgül
- Department of General Surgery, VM Medicalpark Hospital, Kocaeli, Turkey
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5
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Kim MC, Shin S, Koh M. Endoscopic Histoacryl injection for esophagojejunostomy leakage after total gastrectomy in patients with gastric cancer. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:21-27. [PMID: 36936042 PMCID: PMC10020743 DOI: 10.7602/jmis.2023.26.1.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Purpose Esophagojejunostomy leakage after total gastrectomy for gastric cancer is one of the most serious and sometimes life-threatening adverse events. The purpose of this study was to evaluate complications after total gastrectomy in patients with gastric cancer during the period when Histoacryl (B. Braun) injection was performed. Therapeutic outcome of endoscopic Histoacryl injection for esophagojejunostomy leakage was also determined. Methods This was a single-center retrospective study. Between January 2016 and December 2021, clinicopathologic characteristics and surgical outcomes of 205 patients who underwent total gastrectomy were investigated. Baseline characteristics and clinical outcomes of 10 patients with esophagojejunostomy leakage were also investigated. Results Postoperative complication and mortality rates of total gastrectomy in 205 patients were 25.4% and 0.9%, respectively. Serious complications more than Clavien-Dindo IIIb accounted for 6.3%. Ten (4.9%) esophagojejunostomy leakages occurred in 205 patients. Among 10 esophagojejunostomy leakage patients, endoscopic Histoacryl injection was performed on eight patients and leakage was successfully managed with endoscopic Histoacryl injection in seven patients (87.5%). Mean postinjection hospital stay of seven successfully managed patients was 13.8 days. They were able to drink water at 1-6 days after injection. Among eight patients with endoscopic Histoacryl injection, six patients were injected once and two patients were injected three times. Conclusion Endoscopic Histoacryl injection for esophagojejunostomy leakage after total gastrectomy can be considered as a useful treatment for some selected cases.
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Affiliation(s)
- Min Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Sangyun Shin
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Myeongseok Koh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
- Corresponding author Myeongseok Koh, Department of Internal Medicine, Dong-A University College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea, E-mail: , ORCID: https://orcid.org/0000-0002-2000-1196
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6
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Xing J, Xu K, Liu M, Gao P, Tan F, Yao Z, Zhang N, Yang H, Zhang C, Cui M, Su X. Modified π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy: a report of 40 consecutive cases from a single center. J Int Med Res 2022; 50:3000605221116328. [PMID: 35983668 PMCID: PMC9393679 DOI: 10.1177/03000605221116328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Intracorporeal esophagojejunostomy remains a challenging technique in totally
laparoscopic total gastrectomy (TLTG) because of the lack of an established
standard anastomosis method. However, π-shaped esophagojejunostomy in TLTG
is reportedly safe and feasible. Therefore, we evaluated the short-term
surgical outcomes of our modified π-shaped esophagojejunostomy in TLTG. Methods This study involved patients without neoadjuvant therapy diagnosed with
gastric cancer who underwent TLTG by the same surgeon with modified π-shaped
esophagojejunostomy from April 2018 to October 2019. Clinicopathologic data
were collected and retrospectively analyzed. Results Forty patients diagnosed with gastric cancer were included. The mean
operative time and estimated blood loss were 264.6 ± 56.9 minutes and
68.5 ± 53.3 mL, respectively. Postoperative flatus occurred at 4.6 ± 1.7
days. The mean time to resumption of diet was 7.4 ± 1.7 days
postoperatively. One patient was diagnosed with anastomotic leakage and
managed with conservative therapy. Pleural effusion was the most common
complication, occurring in four (10%) patients. One patient developed
intra-abdominal bleeding that required reoperation. Other complications were
atrial fibrillation and wound infection. No mortality occurred during the
6-month follow-up. Conclusions Modified π-shaped esophagojejunostomy is safe and feasible for intracorporeal
anastomosis in TLTG and showed favorable surgical outcomes in this
study.
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Affiliation(s)
- Jiadi Xing
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kai Xu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Maoxing Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Pin Gao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Fei Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhendan Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Nan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hong Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chenghai Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Ming Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiangqian Su
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery IV, Peking University Cancer Hospital & Institute, Beijing, China
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Jin T, Liu HD, Chen ZH, Hu JK, Yang K. Linear Stapler versus Circular Stapler for Patients Undergoing Anastomosis for Laparoscopic Gastric Surgery: A Meta-Analysis. J INVEST SURG 2022; 35:1434-1444. [PMID: 35435081 DOI: 10.1080/08941939.2022.2058126] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Tao Jin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han-Dong Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
| | - Ze-Hua Chen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian-Kun Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kun Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Jintang Hospital, Chengdu, Sichuan, China
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Milone M, Elmore U, Manigrasso M, Vertaldi S, Aprea G, Servillo G, Parise P, De Palma GD, Rosati R. Circular versus linear stapling oesophagojejunostomy after laparoscopic total gastrectomy. A systematic review and meta-analysis. Am J Surg 2021; 223:884-892. [PMID: 34627600 DOI: 10.1016/j.amjsurg.2021.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/24/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND To assess which anastomosis technique is the most appropriate after laparoscopic total gastrectomy, a systematic review with meta-analysis has been performed to evaluate safety and efficacy of the linear versus circular stapler performing the oesophagojejunostomy. METHODS A systematic search was performed using the string: total AND gastrectomy AND (circular OR linear OR stapler). Extracted data were patients' number, gender, age, BMI, ASA Score, tumor stage. Outcomes were leakages, stenoses and bleedings, number of overall anastomotic complications, mortality, operative time, time to first flatus and diet resumption and length of stay of each group. A meta-analysis among the included studies was performed. A subgroup analysis, including the studies in which the Authors considered a single technique to perform each type of anastomosis (LS and CS), was performed. Meta-regression analyses were performed to assess if one or more demographic and clinical variables significantly impacted on the obtained results. RESULTS 12 articles were included in the final analysis. A significant difference was observed in terms of "overall anastomotic complications" in favour of linear stapling (RD = 0.06, p = 0.01). No significant differences were observed in terms of postoperative complications anastomosis-related, even if a trend towards advantages of linear stapling have been found (stenosis: RD = 0.04, p = 0.06; bleeding: RD = 0.02, p = 0.05). However, all the study was retrospective and there was high heterogeneity among the studies. CONCLUSION Linear stapler seems to be related with lesser number of complication if compared with circular stapler. However, further high-quality studies are needed to obtain definitive conclusions.
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Affiliation(s)
- Marco Milone
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Michele Manigrasso
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Sara Vertaldi
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odonthostomatological Sciences, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Paolo Parise
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, "San Raffaele" Scientific Institute, Vita Salute University, Via Olgettina 60, 20132, Milan, Italy
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9
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Park SH, Suh YS, Kim TH, Choi YH, Choi JH, Kong SH, Park DJ, Lee HJ, Yang HK. Postoperative morbidity and quality of life between totally laparoscopic total gastrectomy and laparoscopy-assisted total gastrectomy: a propensity-score matched analysis. BMC Cancer 2021; 21:1016. [PMID: 34511059 PMCID: PMC8436526 DOI: 10.1186/s12885-021-08744-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the surgical outcome and quality of life (QoL) of totally laparoscopic total gastrectomy (TLTG) compared with laparoscopy-assisted total gastrectomy (LATG) in patients with clinical stage I gastric cancer. METHODS From 2012 to 2018, EGC patients who underwent TLTG (n = 223), including the first case with intracorporeal hemi-double stapling, were matched to those who underwent LATG (n = 114) with extracorporeal circular stapling, using 2:1 propensity score matching (PSM). Prospectively collected morbidity was compared between the TLTG and LATG groups in conjunction with the learning curve. The European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaires QLQ-C30, STO22, and OG25 were prospectively surveyed during postoperative 1 year for patient subgroups. RESULTS After PSM, grade I pulmonary complication rate was lower in the TLTG group (n = 213) than in the LATG group (n = 111) (0.5% vs. 5.4%, P = 0.007). Other complications were not different between the groups. The learning curve of TLTG was overcome at the 26th case in terms of the comprehensive complication index. The TLTG group after learning curve showed lower grade I pulmonary complication rate than the matched LATG group (0.5% vs. 4.7%, P = 0.024). Regarding postoperative QoL, the TLTG group (n = 63) revealed less dysphagia (P = 0.028), pain (P = 0.028), eating restriction (P = 0.006), eating (P = 0.004), odynophagia (P = 0.023) than the LATG group (n = 21). Multivariate analyses for each QoL item demonstrated that TLTG was the only common independent factor for better QoL. CONCLUSIONS TLTG reduced grade I pulmonary complications and provided better QoL in dysphagia, pain, eating, odynophagia than LATG for patients with clinical stage I gastric cancer.
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Affiliation(s)
- Shin-Hoo Park
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Foregut Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Yun-Suhk Suh
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Surgery, Seoul National University Bundang Hospital, 137-82 Gumiro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Tae-Han Kim
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Yoon-Hee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Choi
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyuk-Joon Lee
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, 101 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Surgery, Seoul National University Hospital, 103 Daehark-ro, Jongno-gu, Seoul, 03080, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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10
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Yang R, Yang Y, Chen X, Yang Q. A Novel Technique for Extracorporeal Anastomosis: The Bronchus Forceps Is Applied to Reinforce the Esophageal Ring. J Laparoendosc Adv Surg Tech A 2021; 31:1315-1320. [PMID: 34129399 DOI: 10.1089/lap.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: For laparoscopic gastrectomy, it is significant to reduce the incidence of anastomotic leakage. The authors develop a novel technique for safe extracorporeal anastomosis that employs the bronchus forceps to reinforce the esophageal ring. Methods: From January 2017 to July 2020, 173 consecutive patients with gastric cancer received laparoscopic total gastrectomy or laparoscopic proximal gastrectomy. One hundred thirty-one patients only underwent extracorporeal anastomosis with a purse-string suture instrument (PSI) and a 25 mm circular stapler (Ethicon Intraluminal Circular Staplers CDH25A, Ethicon) (Conventional Surgery Group). In addition to these tools for extracorporeal anastomosis, the surgeon creatively used bronchus forceps to reinforce the esophageal ring on the anvil of circular stapler in 42 patients (Bronchus Forceps Ligation Group). The condition and the mean diameter of the narrowest part of the esophageal rings, postoperative outcomes, and complications were compared between the two groups. Results: Under direct vision, the esophageal rings were more complete in the Bronchus Forceps Ligation Group. Furthermore, the mean diameter of the narrowest part of the esophageal rings in the Bronchus Forceps Ligation Group was wider than that in the Conventional Surgery Group (4.34 ± 0.84 versus 2.68 ± 0.74 mm; P < .001). Meanwhile, the incidence of anastomotic leakage was lower in the Bronchus Forceps Ligation Group. Although reinforcing the anvil with the bronchus forceps will add additional surgery time, almost all can be done in less than 5 minutes. Conclusions: With applying the bronchus forceps to reinforce the esophageal ring on the anvil of the circular stapler, the extracorporeal anastomosis can be performed more safely.
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Affiliation(s)
- Rui Yang
- Department of the General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuyi Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xuan Chen
- Department of the General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qingqiang Yang
- Department of the General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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11
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Esophagus two-step-cut overlap method in esophagojejunostomy after laparoscopic gastrectomy. Langenbecks Arch Surg 2021; 406:497-502. [PMID: 33420833 DOI: 10.1007/s00423-021-02079-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Esophagojejunostomy is a challenging step in laparoscopic gastrectomy. Although the overlap method is a safe and feasible approach for esophagojejunostomy, it has several technical limitations. We developed novel modifications for the overlap method to overcome these disadvantages. METHODS Forty-eight consecutive gastric cancer patients underwent totally laparoscopic total gastrectomy or laparoscopic proximal gastrectomy with double-tract reconstruction at our institution from January 2019 to April 2020 using the overlap method with the following modifications. The esophagus was initially rotated by 90° counterclockwise, followed by transection of two-thirds of the esophageal diameter. The unstapled esophagus was then transected with a harmonic ultrasonic scalpel to enable esophagostomy at the posterior side of the esophagus. A side-to-side esophagojejunostomy was then formed at the posterior side of the esophagus using an endoscopic linear stapler through the right lower trocar. The common entry hole was closed via hand sewing method using V-Loc suture. This procedure was termed "esophagus two-step-cut overlap method." RESULTS Only one patient suffered from esophagojejunal anastomotic leakage but subsequently recovered after conservative treatment. Patients did not experience anastomotic bleeding or stricture. CONCLUSION Our modified overlap method provides satisfactory surgical outcomes and overcomes several technical limitations, such as entering the false lumen of the esophagus, unnecessary pollution caused by nasogastric tube, and unintended left crus stapling during anastomosis.
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Abstract
Gastric cancer is still a major cause of death worldwide. While laparoscopic gastrectomy (LG) has gained evidence as a standard treatment for early gastric cancer in the distal stomach, there are still concerns regarding its application for gastric cancer in the upper stomach and advanced gastric cancer. Nevertheless, LG has shown to have faster recovery, shorter hospital stay, less pain, and less blood loss in many retrospective and prospective studies. The application of LG has now extended from conventional radical gastrectomy to novel approaches such as function-preserving gastrectomy and sentinel-node navigated surgery. Studies on the use of laparoscopy in treatment for stage IV gastric cancer are rare, but show that there may be some roles of LG in selected cases. With the development of new laparoscopic tools that augment human ability, the future of LG should move on from proving non-inferiority to demonstrating superiority compared to the traditional open gastrectomy.
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Affiliation(s)
- So Hyun Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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13
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Comparative outcomes between totally laparoscopic total gastrectomy with the modified overlap method for early gastric cancer and advanced gastric cancer: review of 149 consecutive cases. Wideochir Inne Tech Maloinwazyjne 2020; 15:437-445. [PMID: 32904610 PMCID: PMC7457201 DOI: 10.5114/wiitm.2020.96098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) has not been conclusively substantiated. Aim To evaluate TLTG treatment of AGC by comparing its effectiveness and surgical outcomes to those of TLTG treatment of early gastric cancer (EGC). Material and methods We performed TLTG with the (modified) overlap method for 149 gastric cancer cases between March 2012 and December 2018. We evaluated clinicopathologic characteristics, complications (including esophagojejunostomy site complications), and surgical outcomes. We also evaluated these variables in terms of their associations with EGC and AGC. Results Ninety-two males and 57 females, with a mean age of 60.7 years, were included. The mean operation time was 147.7 min. The mean number of harvested lymph nodes was 39.6. Thirteen (8.7%) patients experienced early complications, and 6 (4.0%) experienced late complications (Clavien-Dindo classification ≥ III). Eight (5.4%) patients underwent reoperation, and 8 (5.4%) were readmitted due to complications. There were no statistically significant differences in operation time, hospital stay, or surgical mortality between EGC and AGC. However, there were significant differences in early complications, late complications, rate of reoperation, and rate of readmission between EGC and AGC. Conclusions Although it has some limitations, TLTG with the (modified) overlap method for AGC treatment is feasible, safe, and associated with favorable outcomes.
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Kamarajah SK, Immanuel A. Comparison of totally laparoscopic total gastrectomy and laparoscopic assisted total gastrectomy: A systematic review and meta-analysis. Int J Surg 2019; 69:99. [PMID: 31349050 DOI: 10.1016/j.ijsu.2019.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sivesh K Kamarajah
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom; Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Arul Immanuel
- Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom.
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